NPI | 1477978591 |
---|---|
Former Name | LISA JANE SHINKAROW |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02042) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 4554) |
363AM0700X Physician Assistant Medical (Licence: NJ MA056739) | |
Enumeration Date | 2014-02-26 |
Last Update Date | 2018-12-13 |