NPI | 1316220049 |
---|---|
Former Name | RIKKI L LONG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AR PA-452) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-452) |
363AM0700X Physician Assistant, Medical (Licence: AR PA-452) | |
Enumeration Date | 2011-09-20 |
Last Update Date | 2025-05-08 |