| NPI | 1710902572 |
|---|---|
| Former Name | HEATHER M WYATT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55607) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50001264) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-05-01 |