| NPI | 1497551121 |
|---|---|
| Former Name | AMANDA THEILLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP032501) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R228228) |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-06-06 |