| 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 |