| NPI | 1821342106 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 15336) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61359713) |
| 363A00000X Physician Assistant (Licence: VA 0110004235) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 029464) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00742200) | |
| 363A00000X Physician Assistant (Licence: IN 10004010A) | |
| 363A00000X Physician Assistant (Licence: OH 50.007882RX) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085.010935) | |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2025-12-10 |