| NPI | 1760603997 |
|---|---|
| Former Name | AMANDA JEAN STAFFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 613538) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 263307-1) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2016-12-14 |