| NPI | 1861840084 |
|---|---|
| Former Name | AMY EAGLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10004385A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36001603A) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2024-08-08 |