NPI | 1851726681 |
---|---|
Former Name | LISA KAY DAVES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: HI AMD-1287) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200664) |
363AM0700X Physician Assistant, Medical (Licence: CO PA.0004230) | |
Enumeration Date | 2013-09-11 |
Last Update Date | 2024-01-05 |