| NPI | 1205264108 |
|---|---|
| Former Name | CARLY MICHELLE LOHSTRETER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0751) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52399) |
| 363A00000X Physician Assistant (Licence: MN 11452) | |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2018-11-15 |