| NPI | 1164930046 |
|---|---|
| Former Name | LAURA MARIE BUENNEMEYER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110006615) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-07801) |
| Enumeration Date | 2018-01-13 |
| Last Update Date | 2024-03-06 |