| NPI | 1386875680 |
|---|---|
| Former Name | LAURA A BADE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019043866) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003506) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085-003506) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085-003506) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2020-03-16 |