| NPI | 1568748986 |
|---|---|
| Former Name | COLLEEN HANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA200506) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA07541) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2017-12-19 |