NPI | 1528229036 |
---|---|
Former Name | AMY ANN SIMONEAU |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0005017) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054860) |
363AM0700X Physician Assistant, Medical (Licence: MA AP2536) | |
Enumeration Date | 2008-06-18 |
Last Update Date | 2014-01-24 |