| NPI | 1770891608 |
|---|---|
| Former Name | AMY MARIE OMAHEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002444A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003846) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2025-11-18 |