NPI | 1265678478 |
---|---|
Former Name | TANNA L. STROUP |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003831) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 1782) |
363AM0700X Physician Assistant, Medical (Licence: CO 0003831) | |
Enumeration Date | 2008-12-18 |
Last Update Date | 2015-07-10 |