| NPI | 1659367407 |
|---|---|
| Former Name | DIANA LYNN HERTEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA102544) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102544) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2023-04-13 |