| NPI | 1609150614 |
|---|---|
| Former Name | LAUREN ELIZABETH WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0003957) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0003957) |
| 363A00000X Physician Assistant (Licence: OH 50.003378) | |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2021-04-21 |