| NPI | 1215639745 |
|---|---|
| Former Name | MAKENZIE THOMPSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA218668) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2025-08-20 |