| NPI | 1205697315 |
|---|---|
| Former Name | MONTANNA LEE CHRYSTAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WY PA1221) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PA1221) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-11-14 |