| NPI | 1245635291 |
|---|---|
| Former Name | AMANDA NICOLE MALONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2676) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MS PA00598) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 2676) | |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2023-07-07 |