NPI | 1972804243 |
---|---|
Former Name | KATE EVANGELIST |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DC PA031060) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA.60182624) |
363A00000X Physician Assistant (Licence: NC 0010-03315) | |
Enumeration Date | 2010-11-03 |
Last Update Date | 2014-07-29 |