| NPI | 1215309695 |
|---|---|
| Former Name | CARLA LOUISE LONGANECKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004432) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2018-10-22 |