NPI | 1053430876 |
---|---|
Former Name | STACIE MERRITT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ AZ 5154) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004376) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2014-07-02 |