| NPI | 1326546862 |
|---|---|
| Former Name | STEPHANIE GRACE DIBBLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2022-08-25 |