NPI | 1134724305 |
---|---|
Former Name | AMANDA DARST |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021955) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28263521A) |
363LF0000X Nurse Practitioner, Family (Licence: IN 71010972A) | |
Enumeration Date | 2020-12-03 |
Last Update Date | 2022-11-03 |