NPI | 1366065500 |
---|---|
Former Name | LISA LYNN BAIRD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5353) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11520) |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2020-05-22 |
Last Update Date | 2025-04-21 |