| NPI | 1528095395 |
|---|---|
| Former Name | BRENDA KRISTINE MICKELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 6132263) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2008-05-05 |