NPI | 1316216930 |
---|---|
Former Name | HOLLIE C FAGAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015435) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 15435) |
Enumeration Date | 2011-12-28 |
Last Update Date | 2023-07-06 |