NPI | 1801417613 |
---|---|
Former Name | ANDREA NICOLE OVERMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN 4249) |
Enumeration Date | 2020-05-04 |
Last Update Date | 2023-08-24 |