| NPI | 1972175289 |
|---|---|
| Former Name | ASHELY FANNICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062920) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2025-03-18 |