| NPI | 1912639683 |
|---|---|
| Former Name | CARSON MACKENZIE IDA BREWER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4497) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2024-03-26 |