| NPI | 1912150822 |
|---|---|
| Former Name | KELLIE LYNN DORKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA22268) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005371) |
| 363A00000X Physician Assistant (Licence: PA MA-053827) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2014-07-17 |