| NPI | 1710282074 |
|---|---|
| Other Name | KATIE LEIGH FOSSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1165) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: ID PA-1165) | |
| 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1165) | |
| 363AS0400X Physician Assistant, Surgical | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2021-10-28 |