| NPI | 1700331147 |
|---|---|
| Former Name | ELISSA JO RAINER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3952) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1170) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2021-07-07 |