| NPI | 1336705490 |
|---|---|
| Former Name | MARTHA MARIE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5583-23) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363A00000X Physician Assistant (Licence: MN 13156) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2023-08-08 |