NPI | 1861746158 |
---|---|
Former Name | KORY LYNN BOEING |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003976) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1777) |
363A00000X Physician Assistant (Licence: KY TC159) | |
Enumeration Date | 2012-11-08 |
Last Update Date | 2016-12-30 |