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 |