NPI | 1225404460 |
---|---|
Former Name | KRISTENE MARIE WARD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: LA PA.200869) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA PA.200869) |
363AM0700X Physician Assistant, Medical (Licence: LA PA.200869) | |
Enumeration Date | 2015-08-11 |
Last Update Date | 2015-12-17 |