| NPI | 1366881021 |
|---|---|
| Former Name | AMANDA MARGARET FUSILIER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4337-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110004269) |
| 363A00000X Physician Assistant (Licence: MN 12656) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2018-05-22 |