| NPI | 1568017473 |
|---|---|
| Former Name | AMANDA KAY GOTTWALT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA H155245) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IA H155245) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: IA H155245) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: IA H155245) | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2019-10-04 |