| NPI | 1417360033 |
|---|---|
| Former Name | STEPHANIE LYNN MASSEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 6860) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA056887) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2025-07-30 |