NPI | 1174038764 |
---|---|
Former Name | MELISSA THEIGE RICHIE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15016) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 3063) |
363A00000X Physician Assistant | |
363A00000X Physician Assistant (Licence: ND PAC1093) | |
Enumeration Date | 2017-12-05 |
Last Update Date | 2025-01-09 |