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 |