| NPI | 1083211759 |
|---|---|
| Former Name | CHANISE TIARE MCCLURE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2021-07-23 |