NPI | 1164088977 |
---|---|
Former Name | AMANDA FAYE THOMPSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP000337) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11002465) |
Enumeration Date | 2019-05-16 |
Last Update Date | 2021-12-02 |