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 |