| NPI | 1407858004 |
|---|---|
| Former Name | JUDITH RUBIELA MACNICHOLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA3264) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA3264) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2014-02-19 |