| NPI | 1679047708 |
|---|---|
| Former Name | MARISA BERTOLONE-SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA203098) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 2314) |
| 363A00000X Physician Assistant (Licence: CO PA.0006105) | |
| Enumeration Date | 2019-01-11 |
| Last Update Date | 2023-08-07 |