NPI | 1417288325 |
---|---|
Former Name | KATHRYN DOREMUS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004501A) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA002432) |
363AM0700X Physician Assistant, Medical (Licence: PA MA54269) | |
363A00000X Physician Assistant (Licence: NC 0010-11127) | |
Enumeration Date | 2010-01-18 |
Last Update Date | 2025-01-15 |