| NPI | 1275814204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYESHENE THOMPSON Owner 844-455-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD M560128792557) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238.000139) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: VA 887) | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: VA 2795) | |
| Enumeration Date | 2011-09-04 |
| Last Update Date | 2023-08-23 |