| NPI | 1548260227 |
|---|---|
| Former Name | GINA DOREEN KNUDSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA21749) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX PA07912) |
| 363AM0700X Physician Assistant Medical (Licence: WI 1173023) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2022-05-31 |