| NPI | 1639723711 |
|---|---|
| Former Name | AMANDA MARIE OLIVAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 9411-33) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2024-05-24 |