| NPI | 1417399585 |
|---|---|
| Former Name | STACEY LEANNE BOGDANOWICZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60449258) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA23097) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2025-06-25 |