NPI | 1508168964 |
---|---|
Former Name | BREANNA J WALKER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 1999) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AR PT2020-062) |
Enumeration Date | 2010-11-17 |
Last Update Date | 2022-09-28 |