| NPI | 1104523141 |
|---|---|
| Former Name | COURTNEY SHREVE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: IN 10003934A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003934A) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2024-02-29 |