| NPI | 1972974749 |
|---|---|
| Former Name | MACEY BENTLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11978) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 2356) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2016-06-27 |