NPI | 1720618374 |
---|---|
Former Name | DENISE LYNN CLEM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 1900) |
Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: AZ 1900) |
Enumeration Date | 2020-01-23 |
Last Update Date | 2020-01-23 |