| NPI | 1598007106 |
|---|---|
| Former Name | LACIE ANNA WHITTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 2331) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL 889) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2018-07-24 |