| NPI | 1780613018 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10004690) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA159129) |
| 363A00000X Physician Assistant (Licence: AZ 7072) | |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA10004690) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004690) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-10-21 |