NPI | 1184087744 |
---|---|
Former Name | CLOYCE ELIZABETH NELSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2016-0015) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA175856) |
363AS0400X Physician Assistant Surgical (Licence: OR PA175856) | |
Enumeration Date | 2016-03-31 |
Last Update Date | 2019-05-13 |