NPI | 1366881021 |
---|---|
Former Name | AMANDA MARGARET FUSILIER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4337-23) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004269) |
363A00000X Physician Assistant (Licence: MN 12656) | |
Enumeration Date | 2013-06-17 |
Last Update Date | 2018-05-22 |