| NPI | 1144693284 |
|---|---|
| Former Name | ELLYN GABRIELLE YACKANICZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057837) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA057837) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2023-03-07 |