NPI | 1336267012 |
---|---|
Former Name | LAURIE J BAKER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA07844) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4351) |
363AM0700X Physician Assistant, Medical (Licence: IL 085-002366) | |
Enumeration Date | 2007-03-27 |
Last Update Date | 2023-03-29 |