NPI | 1063979508 |
---|---|
Former Name | MADELINE LEE EISCHEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13422) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5131) |
Enumeration Date | 2019-02-20 |
Last Update Date | 2023-10-20 |