| NPI | 1649819731 |
|---|---|
| Former Name | HEATHER E TETTELBACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4682) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4682) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2021-02-19 |