| NPI | 1346577368 |
|---|---|
| Former Name | BREANNA LEIGH MAYER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2723-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003516) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2019-11-15 |