NPI | 1972886802 |
---|---|
Former Name | TIFFANY CRANE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110004081) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 003372) |
Enumeration Date | 2011-09-27 |
Last Update Date | 2013-01-18 |