| NPI | 1457051658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC000) |
| 363A00000X Physician Assistant (Licence: KY TC397) | |
| 363AM0700X Physician Assistant Medical (Licence: KY TC397) | |
| 363AM0700X Physician Assistant Medical (Licence: KY PA3235) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY TC397) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA3235) | |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-10-25 |