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 |