| NPI | 1801025978 |
|---|---|
| Former Name | LORI JANE DESIMONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10805) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1442) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 013368) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2020-08-21 |