| NPI | 1922561653 |
|---|---|
| Former Name | AMANDA WADE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71009089A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3013285) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-05-08 |