| NPI | 1992113708 |
|---|---|
| Former Name | DANIELLE SCISSOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005737) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005430) |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2020-08-27 |