| NPI | 1962811596 |
|---|---|
| Former Name | TERESA A EDWARDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4315) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 11634) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2020-09-14 |