| 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 |