| 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 |