| NPI | 1366798902 |
|---|---|
| Former Name | AMANDA FAGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 4924-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD 2012005964) |
| 163W00000X Registered Nurse (Licence: WI 191157-30) | |
| 163W00000X Registered Nurse (Licence: IA 119966) | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2021-01-07 |