NPI | 1356640692 |
---|---|
Former Name | BRANDI D. CONNORS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 1598) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.002920) |
363AM0700X Physician Assistant, Medical (Licence: PA MA054844) | |
Enumeration Date | 2011-03-25 |
Last Update Date | 2018-06-29 |