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 |