NPI | 1831790591 |
---|---|
Former Name | BAILEY N. MANTHA-NAGRANT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61101539) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61101539) |
Enumeration Date | 2020-11-07 |
Last Update Date | 2022-08-18 |