| NPI | 1891872438 |
|---|---|
| Former Name | STEPHANIE KRISTINE WICHMANN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA53426) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CA 060002291) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-08-16 |