| NPI | 1689236002 |
|---|---|
| Former Name | ANDREA THELEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010497) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2021-05-28 |