NPI | 1700832326 |
---|---|
Former Name | REBECCA ELLEN BEVERSDORF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.001046) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001046) |
Enumeration Date | 2006-05-25 |
Last Update Date | 2011-01-11 |