NPI | 1063657294 |
---|---|
Former Name | HEATHER HANSEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 2255) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013037) |
Enumeration Date | 2008-12-02 |
Last Update Date | 2022-09-26 |