| NPI | 1366997652 |
|---|---|
| Former Name | AMANDA BLAIR SLAVEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3010612) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2017-03-21 |