| NPI | 1710350608 |
|---|---|
| Former Name | AMANDA ELYSE KOTHEIMER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: OH APRN.CNP.18485) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2018-11-14 |