NPI | 1962907097 |
---|---|
Former Name | REBECCA ANNE BRUBAKER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12933) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-AT-10181353) |
Enumeration Date | 2018-03-29 |
Last Update Date | 2023-02-09 |