| NPI | 1750945978 |
|---|---|
| Former Name | MACY RENAE FRYE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-00706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 250274) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2022-08-19 |