| NPI | 1871744417 |
|---|---|
| Former Name | MEGAN NICHOLE DORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-04531) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04531) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2020-11-05 |