| NPI | 1790024396 |
|---|---|
| Former Name | KATELYNN NICOLE UPHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 22814) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5355) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2022-05-15 |