NPI | 1053789214 |
---|---|
Former Name | TRACY DIANE BURKETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000195) |
Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA 312) |
Enumeration Date | 2015-09-04 |
Last Update Date | 2023-09-11 |