| NPI | 1548801822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2578) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC880) |
| 363AM0700X Physician Assistant, Medical | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2020-12-02 |