| NPI | 1366765679 |
|---|---|
| Former Name | KRISTIN ALYSSE EMANUELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0004810) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04810) |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00232700) | |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2017-11-03 |