| NPI | 1053786632 |
|---|---|
| Former Name | BETHANY LYNN DEYELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05851) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2021-12-06 |