NPI | 1063185072 |
---|---|
Former Name | AMANDA REED |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704300662) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704300662NSA210LV) |
Enumeration Date | 2021-07-26 |
Last Update Date | 2024-10-24 |