| NPI | 1588918122 |
|---|---|
| Former Name | KAYLEE MARIE FARRELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007727) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016201) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2018-03-16 |