| NPI | 1316579154 |
|---|---|
| Former Name | REBEKAH LAINE PETTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010283) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2022-08-26 |