| NPI | 1558871327 |
|---|---|
| Former Name | AMANDA MATTISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704316313) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704316313) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2023-11-17 |