| NPI | 1912560012 |
|---|---|
| Former Name | LAUREN VANDEVELDE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006941) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9112029) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2022-06-06 |