| NPI | 1649674243 |
|---|---|
| Former Name | AMANDA SHUMWAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OK 2791) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 9163864-8906) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2021-01-26 |