| NPI | 1811502578 |
|---|---|
| Former Name | KELLY MARIE CRECELIUS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061846) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2024-04-05 |