NPI | 1790344133 |
---|---|
Former Name | ELIZABETH RODGERS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA A062219) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C07216) |
363A00000X Physician Assistant (Licence: NC 0010-09026) | |
Enumeration Date | 2019-06-10 |
Last Update Date | 2022-06-21 |