| NPI | 1710436647 |
|---|---|
| Former Name | EMMA GRACE NEWBERRY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 2857) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0006234) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2017-11-16 |