| NPI | 1083926505 |
|---|---|
| Former Name | AMANDA LYNN AULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC PA2684) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053995) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2022-07-21 |