NPI | 1285056531 |
---|---|
Former Name | AMANDA JOY SIEKBERT / RUTTLE/GOODMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9283404) |
Enumeration Date | 2014-01-06 |
Last Update Date | 2023-08-23 |