| NPI | 1831900430 |
|---|---|
| Former Name | AMELIA JESSIE BREAZEALE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 30584) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2025-08-05 |