| NPI | 1417351958 |
|---|---|
| Former Name | KELLY ELIZABETH LEESE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057146) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0110006374) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2022-02-18 |