NPI | 1265925382 |
---|---|
Former Name | REBECCA LYNN SHAFFER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12783) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08148) |
363AM0700X Physician Assistant, Medical (Licence: OK 3145) | |
Enumeration Date | 2018-06-13 |
Last Update Date | 2024-05-02 |