| NPI | 1538304837 |
|---|---|
| Former Name | MARIAN JEANETTE BULLARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001001664) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2420) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-01664) | |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2020-12-07 |