NPI | 1013997014 |
---|---|
Former Name | AMANDA L HORST |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 020841-1) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00420700) |
363AM0700X Physician Assistant, Medical (Licence: IN 10002656A) | |
363AM0700X Physician Assistant, Medical (Licence: OH 50.003307) | |
363AM0700X Physician Assistant, Medical (Licence: NE 1042) | |
Enumeration Date | 2006-01-18 |
Last Update Date | 2020-10-29 |