| NPI | 1487384665 | 
|---|---|
| Former Name | KATHRYN REBECCA HANNON | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003873A)  | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2022-06-12 | 
| Last Update Date | 2023-10-09 |