NPI | 1770727497 |
---|---|
Former Name | LAUREN DEAN LANE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA-652) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-652) |
Enumeration Date | 2009-04-24 |
Last Update Date | 2023-05-18 |