| NPI | 1659856656 |
|---|---|
| Former Name | AMANDA JEANETTE DALLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN24590) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN173886) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2024-02-09 |