| NPI | 1689944373 |
|---|---|
| Former Name | KATHLEEN LYNE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1740) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1740) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2020-03-13 |