| NPI | 1760647374 |
|---|---|
| Former Name | AMANDA LYNN SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003624) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002784) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2014-08-25 |