| NPI | 1235873803 |
|---|---|
| Former Name | ALLISSA MARY NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA17510) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 4853) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2024-08-21 |