| NPI | 1629578661 |
|---|---|
| Former Name | ALEXA RENEE ROUSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 4930) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2025-10-02 |