| NPI | 1548754559 |
|---|---|
| Former Name | TRAVIS LANE FARRELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006227) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2019-12-29 |