| NPI | 1104833300 |
|---|---|
| Former Name | MICHELLE J GIBBONS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01791) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 1239) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-08-10 |