| NPI | 1336624089 |
|---|---|
| Former Name | LOGAN ALYSSA RAULERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111646) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9111646) |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2021-03-18 |