NPI | 1518917319 |
---|---|
Former Name | SARA MARIE WISKOW |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09521) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 15352) |
363A00000X Physician Assistant (Licence: PA MA055572) | |
Enumeration Date | 2006-05-11 |
Last Update Date | 2025-08-12 |