| NPI | 1710786157 |
|---|---|
| Former Name | AMANDA FULLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2020002007) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2026033375) |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2026-08-13 |