| NPI | 1245211150 |
|---|---|
| Former Name | TARA R DILLENBURG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005068) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2005029534) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2021-04-15 |