| NPI | 1275802191 |
|---|---|
| Former Name | STEPHANIE N DUMOLT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2015041684) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01501) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2023-10-13 |