| NPI | 1962136051 |
|---|---|
| Former Name | KELLI VAN TASSEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008665) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0008665) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2026-01-20 |