NPI | 1902324205 |
---|---|
Former Name | MARISSA TENNANT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 3987) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: RI PA01528) |
363A00000X Physician Assistant | |
Enumeration Date | 2017-09-07 |
Last Update Date | 2025-09-04 |