NPI | 1093060550 |
---|---|
Former Name | BETHANY BRYN ALLAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3737) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0905) |
363AM0700X Physician Assistant, Medical (Licence: CO PA0004764) | |
363AM0700X Physician Assistant, Medical (Licence: SC 3737) | |
Enumeration Date | 2012-07-19 |
Last Update Date | 2022-03-02 |