| NPI | 1215492889 |
|---|---|
| Former Name | LAURA LEE FANGMEYER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C07918) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12576) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2022-10-20 |