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 |