| NPI | 1588338602 |
|---|---|
| Former Name | TEEGAN MICHAIAH LUCKEMEYER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14682) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2025-05-28 |