| NPI | 1144303900 |
|---|---|
| Former Name | DONNA FAYE MOULTRY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1305) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1038986) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2019-08-07 |