NPI | 1922258821 |
---|---|
Former Name | TIFFANY GENET BURNSIDE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19942) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA-C19942) |
Enumeration Date | 2008-09-26 |
Last Update Date | 2022-01-04 |