| NPI | 1013306596 |
|---|---|
| Former Name | AMANDA FREDERICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 32210) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2007031264) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2024-01-03 |