NPI | 1316029630 |
---|---|
Former Name | KELLIE LYNN SCHNEIDER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.460) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL PA-460) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2022-07-21 |