| NPI | 1710535562 |
|---|---|
| Former Name | GRACEY ANNA GIBERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA195805) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2025-02-11 |