| NPI | 1154919769 | 
|---|---|
| Former Name | AMANDA ELIZABETH BEHNKE | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 10410) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 10410-33) | 
| Enumeration Date | 2021-01-08 | 
| Last Update Date | 2021-01-19 |