| NPI | 1346589876 |
|---|---|
| Former Name | MIKAELA A DIERKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: SD 1417) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NE 1709) |
| 363AM0700X Physician Assistant Medical (Licence: MN 2069) | |
| 363AM0700X Physician Assistant Medical (Licence: MN 11579) | |
| 363A00000X Physician Assistant (Licence: MN 11579) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2024-01-10 |