NPI | 1457809550 |
---|---|
Former Name | STEPHANIE BERTRAND |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61147744) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61147744) |
363AM0700X Physician Assistant, Medical (Licence: WA PA61147744) | |
363AM0700X Physician Assistant, Medical (Licence: OR PA190844) | |
Enumeration Date | 2016-09-17 |
Last Update Date | 2021-05-13 |