| NPI | 1710020367 |
|---|---|
| Former Name | LORRAINE THERESA CLEMENT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02452) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PT796) |
| 363AM0700X Physician Assistant, Medical (Licence: WY PT796) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WY PT796) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2022-02-16 |