| NPI | 1104472794 |
|---|---|
| Former Name | TANYA GLENNA THOMPSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3910) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TN 6244) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 3910) | |
| Enumeration Date | 2019-08-10 |
| Last Update Date | 2023-09-11 |