| NPI | 1396135414 |
|---|---|
| Former Name | AMY DAWN MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1042) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL TA. 1791) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2018-03-17 |