NPI | 1851855241 |
---|---|
Former Name | KELSEY REA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110006547) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2019-01-30 |
Last Update Date | 2024-03-05 |