| NPI | 1275959942 |
|---|---|
| Former Name | LEAH IVY RICKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.2107) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2014005588) |
| 363A00000X Physician Assistant (Licence: SC TL2808) | |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2023-09-21 |