| 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 |