| NPI | 1578927190 |
|---|---|
| Former Name | KATIE LYNN HANCOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 62550) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN RP# 27829) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2020-08-25 |