| NPI | 1740447986 |
|---|---|
| Former Name | AMANDA STEPHANIE CLEMENT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 5307) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005307) |
| 363A00000X Physician Assistant (Licence: FL PA9104515) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2011-12-29 |