| NPI | 1447810197 |
|---|---|
| Former Name | GRACE CARLISLE BLACKLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006693) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0007205) |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2023-03-30 |