NPI | 1336747120 |
---|---|
Former Name | MIKAYLA LYNN PAYNE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1960) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID M-9901) |
363A00000X Physician Assistant (Licence: ID M-9901) | |
Enumeration Date | 2020-10-13 |
Last Update Date | 2023-04-24 |