NPI | 1477942092 |
---|---|
Former Name | AMANDA NICOLE ROTERT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2015000406) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209027428) |
363L00000X Nurse Practitioner (Licence: IN 71015197A) | |
Enumeration Date | 2015-01-20 |
Last Update Date | 2024-06-07 |