| NPI | 1316359912 |
|---|---|
| Former Name | KATHERINE NYSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05001) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05001) |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2021-02-25 |