| NPI | 1356088603 |
|---|---|
| Former Name | MAKENNA JEAN LEATHERWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0008185) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15863) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-12-14 |