| NPI | 1811547011 |
|---|---|
| Former Name | KIRSTEN MICHELLE WOODFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA OA004985) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: PA MA060990) |
| 363AM0700X Physician Assistant Medical (Licence: PA MA060990) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2022-11-29 |