| NPI | 1740698737 |
|---|---|
| Former Name | AMANDA RENE GLASSCOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 897) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN CNP897) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MN R1857391) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2020-10-06 |