| NPI | 1508167867 |
|---|---|
| Former Name | TARA J CHESTNUT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WV 1077) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: WV 1077) |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2024-02-08 |