NPI | 1912309766 |
---|---|
Former Name | CHRISTINA PENICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1971) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC345) |
Enumeration Date | 2014-09-24 |
Last Update Date | 2018-09-11 |