| NPI | 1124570932 |
|---|---|
| Former Name | AMANDA MARIE BALISE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AK 165997) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60833518) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2022-07-21 |