| NPI | 1285157958 |
|---|---|
| Former Name | BRANDY MACON EUGENE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2017025341) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085006152) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-07-21 |