| NPI | 1326190703 |
|---|---|
| Former Name | BRENDA L BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2877-23) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2024-05-31 |