| NPI | 1235673203 |
|---|---|
| Former Name | AMANDA LOUISE PROCZAK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15339) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 86056) |
| Enumeration Date | 2016-12-11 |
| Last Update Date | 2025-07-07 |