| NPI | 1104151729 |
|---|---|
| Former Name | HOLLY MARIE O'GRADY VANBENCOTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02105) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2024-06-11 |