NPI | 1942620372 |
---|---|
Former Name | AMANDA J FORD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277000592) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277000592) |
Enumeration Date | 2014-04-24 |
Last Update Date | 2022-08-22 |