NPI | 1912474149 |
---|---|
Former Name | KRISTEN BILSTAD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7405) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 7405) |
Enumeration Date | 2018-10-25 |
Last Update Date | 2022-07-29 |