NPI | 1245617802 |
---|---|
Former Name | AMANDA LYNNE STUCK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17191) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO2319) |
207Q00000X Family Medicine (Licence: NV SL1068) | |
Enumeration Date | 2015-05-04 |
Last Update Date | 2021-02-03 |