| NPI | 1144853169 |
|---|---|
| Former Name | ALICIA LORRAINE BENNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4949) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 4949-23) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2024-01-25 |