NPI | 1699764092 |
---|---|
Former Name | MANDA LOREE SLOAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM 95-PA-15) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 572) |
Enumeration Date | 2005-10-18 |
Last Update Date | 2021-07-10 |