| NPI | 1780339028 |
|---|---|
| Former Name | COURTNEY LEE-PAIGE WIENCKOWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115718) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA9186) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2024-06-03 |