NPI | 1083719181 |
---|---|
Former Name | TANA MARIE WHITE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR PA-240) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-240) |
Enumeration Date | 2006-09-13 |
Last Update Date | 2020-02-04 |