| NPI | 1184860983 |
|---|---|
| Former Name | AMANDA FULLERTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 825927) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201404840NP-PP) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN13902) | |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2021-04-07 |