NPI | 1225201288 |
---|---|
Former Name | AMANDA JEANNE DIERKING |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3006098) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 852185) |
363LF0000X Nurse Practitioner, Family (Licence: TX AP125268) | |
363LF0000X Nurse Practitioner, Family (Licence: KY 3006098) | |
Enumeration Date | 2008-04-10 |
Last Update Date | 2023-02-19 |