| NPI | 1104101435 |
|---|---|
| Former Name | LAUREN KELLY OGLESBEE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 200.500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00672) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2023-01-04 |