| NPI | 1164985867 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID 3271156) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 4845) | 
| 363A00000X Physician Assistant (Licence: KY PA2816) | |
| 363AM0700X Physician Assistant, Medical (Licence: KY TC074) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-09 | 
| Last Update Date | 2025-07-21 |