NPI | 1184874919 |
---|---|
Former Name | AMANDA DAWN HORNBERGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 2665) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2665) |
Enumeration Date | 2008-09-29 |
Last Update Date | 2020-02-10 |