| NPI | 1518262542 |
|---|---|
| Former Name | STEPHANIE L WEATHERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 4291) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4291) |
| 363A00000X Physician Assistant (Licence: OK APA1969) | |
| 363AS0400X Physician Assistant, Surgical (Licence: OK APA1969) | |
| Enumeration Date | 2011-01-23 |
| Last Update Date | 2019-12-19 |