NPI | 1083323190 |
---|---|
Former Name | EMILY NICOLE NELSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14273) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 14273) |
363AM0700X Physician Assistant, Medical (Licence: MN 14273) | |
Enumeration Date | 2022-11-17 |
Last Update Date | 2023-06-09 |