| NPI | 1750824595 |
|---|---|
| Former Name | AMANDA L RUCKERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11018412) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016072) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2022-07-18 |