| NPI | 1689206088 |
|---|---|
| Former Name | STEPHANIE RANDOLPH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0008083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10268) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2024-10-17 |