| NPI | 1811083546 |
|---|---|
| Former Name | TAMARA BLANK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2014-0063) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 10000435A) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-11-16 |