NPI | 1235551706 |
---|---|
Former Name | NICHOLE RAE MILLS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004372) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363AS0400X Physician Assistant, Surgical (Licence: CO PA.004372) | |
Enumeration Date | 2014-01-17 |
Last Update Date | 2018-10-23 |