NPI | 1720318892 |
---|---|
Former Name | MARY ANN SHERIDAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51559) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054136) |
363AS0400X Physician Assistant, Surgical (Licence: CA 51559) | |
Enumeration Date | 2010-01-12 |
Last Update Date | 2023-04-24 |