NPI | 1124458856 |
---|---|
Former Name | ANDREA J BURNETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005078RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056497) |
363A00000X Physician Assistant (Licence: PA OA003197) | |
Enumeration Date | 2013-11-15 |
Last Update Date | 2019-12-13 |