NPI | 1700517422 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3225) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC394) |
363AM0700X Physician Assistant, Medical (Licence: KY TC394) | |
363AM0700X Physician Assistant, Medical (Licence: KY PA3225) | |
363AS0400X Physician Assistant, Surgical (Licence: KY TC394) | |
363AS0400X Physician Assistant, Surgical (Licence: KY PA3225) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-06-22 |
Last Update Date | 2023-10-25 |