| NPI | 1336650712 |
|---|---|
| Former Name | ELISE MARIE VAN PELT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 021853) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2024-11-17 |