| NPI | 1235404146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7588) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03691) |
| 363A00000X Physician Assistant (Licence: RI PA00939) | |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA7588) | |
| 363AS0400X Physician Assistant, Surgical (Licence: RI PA00939) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-03691) | |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2020-09-11 |