| NPI | 1972058048 |
|---|---|
| Former Name | KATELYNN BROOKE SUMKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10856926-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-005492) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2021-08-24 |