NPI | 1760963201 |
---|---|
Former Name | PAIGE TYNE REDIFER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006185) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-08-23 |
Last Update Date | 2024-02-22 |