NPI | 1093101768 |
---|---|
Former Name | AMANDA LYNNE KRAFT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 76701) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015005058) |
Enumeration Date | 2015-04-09 |
Last Update Date | 2019-10-07 |