NPI | 1093010720 |
---|---|
Former Name | VALERIE LYNN WENGERT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105825) |
Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL PA9105825) |
363A00000X Physician Assistant (Licence: FL PA9105825) | |
Enumeration Date | 2011-01-11 |
Last Update Date | 2018-10-30 |