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 |