| NPI | 1780383661 |
|---|---|
| Former Name | AMANDA DANIELLE DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 72277) |
| Additional Taxonomies | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: NM 72277) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2023-07-13 |