| NPI | 1811182710 |
|---|---|
| Former Name | HEATHER RUTH CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2863) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05331) |
| 363A00000X Physician Assistant (Licence: MI 5601006938) | |
| 363A00000X Physician Assistant (Licence: VA 0110005244) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2016-01-07 |