NPI | 1811376320 |
---|---|
Former Name | ANASTASIA J REYNOLDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.004279RX) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA057569) |
Enumeration Date | 2015-05-29 |
Last Update Date | 2025-04-22 |