NPI | 1063750719 |
---|---|
Former Name | TAMRA DEE WARNER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006513) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11425) |
363A00000X Physician Assistant (Licence: CA 22804) | |
Enumeration Date | 2013-01-30 |
Last Update Date | 2022-01-16 |