| NPI | 1538636345 |
|---|---|
| Former Name | MARIAH JORDAN MCCALLUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006527) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 3098) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 3098) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2023-02-01 |