| NPI | 1114701406 |
|---|---|
| Former Name | AMY MARIE FAIRBANKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10359) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 10359) |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2023-10-19 |