| NPI | 1922597384 |
|---|---|
| Former Name | KATELYN BALTES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 119642) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006845) |
| 363A00000X Physician Assistant (Licence: WI 4339-23) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2023-12-20 |