| NPI | 1104002849 |
|---|---|
| Former Name | STEPHANIE MESSICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3250) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0000601) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2022-09-26 |