NPI | 1316151392 |
---|---|
Former Name | SUZANNE ELIZABETH LIVENGOOD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 858) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC 858) |
363AS0400X Physician Assistant, Surgical (Licence: SC 858) | |
Enumeration Date | 2007-05-09 |
Last Update Date | 2024-08-21 |