NPI | 1962023689 |
---|---|
Former Name | LAUREN MARGARET SPOENEMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 10890) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-007114) |
Enumeration Date | 2020-05-04 |
Last Update Date | 2024-07-09 |