NPI | 1295722270 |
---|---|
Former Name | KAREN L VANDAELE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003196) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50001431) |
363AS0400X Physician Assistant, Surgical (Licence: MI 5601003196) | |
363A00000X Physician Assistant (Licence: OH 50001431) | |
Enumeration Date | 2005-10-04 |
Last Update Date | 2023-10-23 |