NPI | 1558902890 |
---|---|
Former Name | EILEEN FAUTEUX |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61389905) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-006836) |
363AS0400X Physician Assistant, Surgical (Licence: WA PA61389905) | |
Enumeration Date | 2019-10-07 |
Last Update Date | 2023-11-03 |