| NPI | 1003166984 |
|---|---|
| Former Name | AMANDA PHOENIX |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2025008599) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004469) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2025-04-10 |