| NPI | 1730623802 |
|---|---|
| Former Name | CATHERINE LYNN FENNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7804) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2021-02-17 |