NPI | 1740567585 |
---|---|
Former Name | BROOKE HOESTEREY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005749) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2026) |
363A00000X Physician Assistant (Licence: CA 22912) | |
Enumeration Date | 2011-11-08 |
Last Update Date | 2019-09-19 |