| NPI | 1649622515 |
|---|---|
| Former Name | ERIN RAE TYE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WV 2191) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WV 714) |
| 363A00000X Physician Assistant (Licence: WV 714) | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2022-03-23 |