| NPI | 1740516301 |
|---|---|
| Former Name | COURTNEY L THERIAULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA1192) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1192) |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2021-12-08 |