| NPI | 1376265959 |
|---|---|
| Former Name | GRACE MARIE TALBERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12660) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2022-11-14 |