NPI | 1578979936 |
---|---|
Former Name | KRISTEN ELIZABETH WHITE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05741) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00339000) |
Enumeration Date | 2014-07-07 |
Last Update Date | 2015-07-01 |