| NPI | 1891173258 |
|---|---|
| Former Name | CASEY FAZER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12022) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 2395) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2022-07-21 |