| NPI | 1972736908 |
|---|---|
| Former Name | KATHERINE ELIZABETH FOUNTAIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601002401) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2009-08-25 |