Individual
AUTUMN KRYSTAL VALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-003712
IL
363A00000X
Physician Assistant
2541-023
WI
363AS0400X
Surgical Physician Assistant
Primary
2541
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356664346
—
WI
Enumeration date
03/05/2010
Last updated
04/21/2015
Update your record
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