NPI | 1861782062 |
---|---|
Former Name | STACY MARIE DUNNE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0005299) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004633RX) |
363A00000X Physician Assistant (Licence: NC 001002754) | |
Enumeration Date | 2011-04-10 |
Last Update Date | 2021-04-14 |