| NPI | 1760515688 |
|---|---|
| Former Name | AMY DIANE BANES CRAIG NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008197) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-06561) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-08-19 |