| NPI | 1275053514 |
|---|---|
| Former Name | ANGELA DENISE VAIL, FREEBORN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60769549) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA PA60769549) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2021-04-16 |