| NPI | 1225395544 |
|---|---|
| Former Name | HEATHER LYNN BRUNELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 10528186-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106253) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2021-12-16 |