| NPI | 1053577213 |
|---|---|
| Former Name | LAINEY AMANDA MEDINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107181) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA.2002.39RX) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2020-06-22 |