| NPI | 1437491115 |
|---|---|
| Former Name | TERESSA ELIZABETH HAEFELE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA168447) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2020-12-29 |