| NPI | 1497398465 |
|---|---|
| Former Name | AMANDA MICHELLE CRUZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: TX 186098) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 186098) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2019-10-23 |