| NPI | 1801549761 |
|---|---|
| Former Name | GRACE ELIZABETH CAMPBELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00875100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA063344) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2024-10-16 |