| NPI | 1679592315 |
|---|---|
| Former Name | AMANDA D. JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03544) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004518) |
| 363A00000X Physician Assistant (Licence: VA 0110002055) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-01-04 |