| NPI | 1194385567 |
|---|---|
| Former Name | AMBER JEAN LYSTIG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14917) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4750-23) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-06-11 |