| NPI | 1376803189 |
|---|---|
| Former Name | LATOYA TRENISE BOLDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA031955) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04725) |
| 363A00000X Physician Assistant (Licence: MA PA9481) | |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA08440) | |
| 363AM0700X Physician Assistant, Medical (Licence: MD C04725) | |
| Enumeration Date | 2012-05-26 |
| Last Update Date | 2023-11-10 |