NPI | 1770073587 |
---|---|
Former Name | ASHTON MARIE HIATT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009916) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-02205) |
Enumeration Date | 2018-05-16 |
Last Update Date | 2023-09-25 |