| NPI | 1770557993 |
|---|---|
| Former Name | BROOKE ANNE TIETSORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0002000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 2000) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2025-01-31 |