NPI | 1881217594 |
---|---|
Former Name | TAYLOR WONDRA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02394) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-05-28 |
Last Update Date | 2022-12-08 |