| NPI | 1508958539 |
|---|---|
| Former Name | MEGAN M. EDSTROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0001843) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 1843) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO 1843) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2015-06-16 |