| NPI | 1881956696 |
|---|---|
| Former Name | CHARLOTTE JOY CLANCY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002758) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002758) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 002758) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2015-02-18 |