NPI | 1861092421 |
---|---|
Former Name | MADISON ANN CLINE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50.008232RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-10911) |
Enumeration Date | 2020-10-31 |
Last Update Date | 2024-08-20 |