NPI | 1457612848 |
---|---|
Former Name | AMANDA O'STEEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0061542) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A127022) |
207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0061542) | |
207QS0010X Family Medicine, Sports Medicine (Licence: MO 2023000976) | |
Enumeration Date | 2012-06-02 |
Last Update Date | 2023-01-27 |