| NPI | 1205019957 |
|---|---|
| Former Name | ELIZABETH LEANNE MAYBERRY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1283) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC TL1283) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2023-11-28 |