NPI | 1629406434 |
---|---|
Former Name | LAUREN ELIZABETH POTESTATO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007610) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003910) |
Enumeration Date | 2013-10-15 |
Last Update Date | 2024-03-26 |