| NPI | 1659833986 |
|---|---|
| Former Name | ASHLEE LAUREN TISDALE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 123829) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2024-04-16 |