NPI | 1679064760 |
---|---|
Former Name | ALYSSA MCKINNEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7014) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1942) |
Enumeration Date | 2018-05-23 |
Last Update Date | 2022-12-08 |