NPI | 1215445275 |
---|---|
Former Name | KATHRYN L MAYO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12641) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55268) |
Enumeration Date | 2018-01-11 |
Last Update Date | 2023-12-04 |