NPI | 1528193802 |
---|---|
Former Name | TRACI ALICE FEATHERSTONE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05225) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 6482385-8906) |
363AM0700X Physician Assistant, Medical (Licence: UT 6482385-1206) | |
Enumeration Date | 2007-02-23 |
Last Update Date | 2018-03-17 |