NPI | 1407245103 |
---|---|
Former Name | LAUREN RICHARDSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05518) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3099) |
Enumeration Date | 2015-01-18 |
Last Update Date | 2016-12-28 |