NPI | 1871609693 |
---|---|
Former Name | PATRICIA LEE RARDIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06097) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-001309) |
Enumeration Date | 2006-08-22 |
Last Update Date | 2018-06-01 |