NPI | 1275013526 |
---|---|
Former Name | AMANDA RENEE HARRISON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA64520) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 08390) |
Enumeration Date | 2018-08-16 |
Last Update Date | 2025-10-06 |