| NPI | 1487634366 |
|---|---|
| Former Name | PHYLLIS A CARPENTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 238.000045) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 238000045) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 237000011) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2018-09-06 |