| NPI | 1952093635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3253) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA3253) | |
| 363AM0700X Physician Assistant Medical (Licence: KY TC025) | |
| 363A00000X Physician Assistant (Licence: KY TC025) | |
| 363AM0700X Physician Assistant Medical (Licence: KY PA3253) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY TC025) | |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-01-10 |