| NPI | 1780979971 |
|---|---|
| Former Name | MARISA WORTLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006014) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108031) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2019-08-21 |