| NPI | 1669838983 |
|---|---|
| Former Name | MICHELLE RENE TEDDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2563) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 2563) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2021-08-27 |