NPI | 1801269642 |
---|---|
Former Name | HEATHER NICOLE LOVE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA057998) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003692) |
Enumeration Date | 2015-11-02 |
Last Update Date | 2015-11-02 |