| NPI | 1790072452 |
|---|---|
| Former Name | ELLIE M O'CONNELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA056680) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014826) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2016-11-09 |