NPI | 1356606479 |
---|---|
Former Name | CASEY LYNN MILLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055525) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA055525) |
Enumeration Date | 2012-07-05 |
Last Update Date | 2022-03-18 |