| NPI | 1790284529 |
|---|---|
| Former Name | AMANDA JACKSON-SCHENK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007762A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28196171A) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2021-12-14 |