| NPI | 1811390313 |
|---|---|
| Former Name | KATHERINE R MOREDOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 2190) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 2190) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2019-03-27 |