| NPI | 1588909659 |
|---|---|
| Former Name | AMANDA JEANETTE ECKLUND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055829) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA055829) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2024-08-06 |