| NPI | 1295814119 |
|---|---|
| Former Name | TARA KENDALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 003174) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003748) |
| 363A00000X Physician Assistant (Licence: RI PA 00782) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2015-11-25 |