| NPI | 1306964994 |
|---|---|
| Former Name | KATIE DIANA MALLABURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1501) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: ID 21614) |
| 363AM0700X Physician Assistant, Medical | |
| 376K00000X Nurse's Aide (Licence: ID 00048770602) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2023-11-01 |