| NPI | 1760155105 |
|---|---|
| Former Name | ALLISON LYNN GARDNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 5646) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5646-23) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2024-02-01 |