NPI | 1659689123 |
---|---|
Former Name | REBECCA CATHERINE DAVENPORT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA4037) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4037) |
Enumeration Date | 2010-09-18 |
Last Update Date | 2010-09-18 |