| NPI | 1528624772 |
|---|---|
| Former Name | MADISON B STAUB |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006736) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2021-12-27 |