| NPI | 1386088748 |
|---|---|
| Former Name | MICHELLE LEE LACKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60307491) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60307491) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2021-01-04 |