| NPI | 1104852094 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10495) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6669778-1206) | 
| 363A00000X Physician Assistant (Licence: AZ 3127) | |
| 363A00000X Physician Assistant (Licence: OK 1414) | |
| 363A00000X Physician Assistant (Licence: OR PA223121) | |
| 363A00000X Physician Assistant (Licence: AK PADA1230) | |
| 363A00000X Physician Assistant (Licence: CA PA65471) | |
| Enumeration Date | 2006-06-23 | 
| Last Update Date | 2025-05-18 |