| NPI | 1487369641 |
|---|---|
| Former Name | AMELIA JEAN SOUTHWORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health (Licence: AK 215323) |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2023-10-27 |