| NPI | 1295389849 |
|---|---|
| Former Name | CARLY ELIZABETH MISCHELLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0110-006780) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2021-09-01 |