NPI | 1376892505 |
---|---|
Former Name | MELISSA NICOLE YORTY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA ma055704) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2012-09-04 |
Last Update Date | 2018-11-20 |