| NPI | 1245785013 |
|---|---|
| Former Name | AMANDA PEGEEN SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 6612) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 6612) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2024-05-09 |