NPI | 1265570766 |
---|---|
Former Name | ELIZABETH JEAN RUSSELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004629) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004629) |
363AM0700X Physician Assistant, Medical (Licence: MO 2006032146) | |
Enumeration Date | 2007-02-05 |
Last Update Date | 2018-10-18 |