| NPI | 1285721050 |
|---|---|
| Former Name | MICHELLE THEOBALD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA349) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA349) |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA349) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-11-02 |