| NPI | 1306205885 |
|---|---|
| Former Name | MICHELLE REGAN SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-645) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PT2016-009) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-04-12 |