NPI | 1295117414 |
---|---|
Former Name | MOLLY K WHEATLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA187229) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: OR LD10162938) |
Enumeration Date | 2015-06-24 |
Last Update Date | 2022-02-15 |