| NPI | 1871118448 |
|---|---|
| Former Name | AMANDA NICHOLE KLUKAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: PA SP022852) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: PA SP022852) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-01-10 |