| NPI | 1588400188 |
|---|---|
| Former Name | TIFFANY LEE CAMPO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA61614861) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA DH00007862) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2024-11-12 |