| NPI | 1588950042 |
|---|---|
| Former Name | HEATHER LAREE DALE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003618) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1356) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2012-07-24 |