| NPI | 1699762203 |
|---|---|
| Former Name | MICHELLE PENNINGTON LILES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1812) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN 1812) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2022-06-24 |