NPI | 1154844488 |
---|---|
Former Name | KORTNEY KRUEGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WI 4360-23) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4360-23) |
Enumeration Date | 2017-07-19 |
Last Update Date | 2024-07-10 |