| NPI | 1700218682 |
|---|---|
| Former Name | LARA ANN HEISE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60398940) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA 60398940) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA 60398940) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2022-06-27 |