NPI | 1356690275 |
---|---|
Former Name | ELIZABETH JANE DOTTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006739) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00308200) |
363A00000X Physician Assistant (Licence: NY 015906) | |
Enumeration Date | 2012-09-06 |
Last Update Date | 2023-10-17 |