| NPI | 1407247828 |
|---|---|
| Former Name | MELINDA LACKORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50005095RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05583) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2022-07-21 |