NPI | 1285143529 |
---|---|
Other Name | TERRA M FODSTAD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14042) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6912) |
Enumeration Date | 2017-09-28 |
Last Update Date | 2023-12-01 |