| NPI | 1124545041 |
|---|---|
| Former Name | JOY FREDRICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2022-10-28 |