| NPI | 1962484154 |
|---|---|
| Former Name | LAURA B DESILETS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 0550030965) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001719) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2019-02-17 |