NPI | 1558614610 |
---|---|
Former Name | LAURA LYNN DIXON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK PADA1087) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 2230) |
Enumeration Date | 2012-10-25 |
Last Update Date | 2023-11-09 |