| NPI | 1346970654 |
|---|---|
| Former Name | IVY MEG EDWARDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2471V0106X Radiologic Technologist Vascular-Interventional Technology (Licence: ID 541174) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-10-06 |