| NPI | 1861757080 |
|---|---|
| Former Name | KRISTINA LEA MALLECK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0003478) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0003478) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2024-04-09 |