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 |