| NPI | 1902127442 |
|---|---|
| Former Name | AMANDA RAE GOODENBERGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 30277) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-36564) |
| 208000000X Pediatrics (Licence: MO 2012008172) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2018-01-24 |