| NPI | 1316120181 |
|---|---|
| Former Name | KAYLEEN MARIE CARNAHAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR PA01313) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA01313) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2024-09-18 |