| NPI | 1215291869 |
|---|---|
| Former Name | MARIE CLAIRE MIKKELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07908) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA07908) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2018-04-05 |