NPI | 1114121936 |
---|---|
Former Name | ROXANN STACHIW |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD PA75548) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC F 2572) |
Enumeration Date | 2007-06-14 |
Last Update Date | 2012-06-26 |