NPI | 1114300977 |
---|---|
Former Name | DANIELLE ASHLEY DEPEAU |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 11006) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 018812) |
Enumeration Date | 2015-06-29 |
Last Update Date | 2022-05-18 |