| NPI | 1851154256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61523671) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA219565) |
| 363AM0700X Physician Assistant, Medical (Licence: WA 1218544) | |
| 363AM0700X Physician Assistant, Medical (Licence: OR PA219565) | |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-09-27 |