NPI | 1447690714 |
---|---|
Former Name | REBECCA A RUSSELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 016636) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 016636) |
Enumeration Date | 2013-07-01 |
Last Update Date | 2022-05-25 |