NPI | 1841587789 |
---|---|
Former Name | JUDITH MARIE CODDINGTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005075) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 006132) |
363AM0700X Physician Assistant, Medical (Licence: MD C0005383) | |
Enumeration Date | 2011-06-29 |
Last Update Date | 2015-11-03 |