NPI | 1396933867 |
---|---|
Former Name | CARRLENE BERRY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3687) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 3687) |
Enumeration Date | 2007-10-10 |
Last Update Date | 2020-09-03 |