| NPI | 1639540578 |
|---|---|
| Former Name | RACHEL ELAINE BALLWEG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5535-023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.005415) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2022-04-20 |