NPI | 1508268491 |
---|---|
Former Name | CHELSEA A VAN DYKE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0762) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 1012) |
363A00000X Physician Assistant (Licence: MN 12887) | |
Enumeration Date | 2014-09-23 |
Last Update Date | 2025-02-26 |