| NPI | 1992793525 |
|---|---|
| Former Name | CORALEE RUTH LOBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA14217) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60188369) |
| 363A00000X Physician Assistant (Licence: OR PA153205) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2021-09-14 |