NPI | 1659473692 |
---|---|
Former Name | ERICKA LEA STOOR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA053070) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00083500) |
363A00000X Physician Assistant (Licence: IL 085004536) | |
Enumeration Date | 2006-09-01 |
Last Update Date | 2023-02-08 |