| NPI | 1679721179 |
|---|---|
| Former Name | ELIZABETH ANN PARKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2022029696) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003294) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2023-05-02 |