| NPI | 1861971590 |
|---|---|
| Former Name | STEPHANIE L MOOSMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 7214) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7214) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2023-05-23 |