| NPI | 1124663604 |
|---|---|
| Former Name | SAMANTHA CRAGO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA062959) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-10538) |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2022-01-13 |