| NPI | 1346767209 |
|---|---|
| Former Name | AUDRA SUE VANDYKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 030568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008375) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2023-11-08 |