| NPI | 1538812805 |
|---|---|
| Former Name | BROOK LYNN RODDENBERRY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12578) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13447) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9115415) | |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2024-10-14 |