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Individual
CECILIA ANANIA BACKSTROM
Active
Individual
CECILIA ANANIA BACKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1294
NE
363A00000X
Physician Assistant
15-00317
KS
363A00000X
Physician Assistant
1875
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100342400A
—
KS
Enumeration date
11/18/2005
Last updated
07/10/2013
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