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Individual
NEENAH GRADE
Active
Individual
NEENAH GRADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
53586
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53586
STATE LICENSE NUMBER
CA
Enumeration date
07/14/2016
Last updated
02/08/2018
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