| NPI | 1669853628 |
|---|---|
| Former Name | AMANDA MICHEL VIERECK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057653) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00369500) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2019-10-04 |