| NPI | 1295156768 |
|---|---|
| Former Name | MADDIE HOLT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 68225) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WY PT587) |
| 363AM0700X Physician Assistant Medical (Licence: WY TL587) | |
| 363AM0700X Physician Assistant Medical (Licence: WY PA587) | |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2024-04-05 |