| NPI | 1982738548 |
|---|---|
| Former Name | ANDREA MICHELLE MCNUTT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110004497) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126 000034) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2023-08-10 |