NPI | 1952612749 |
---|---|
Former Name | AMBER NIELSEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5061) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.679) |
363A00000X Physician Assistant (Licence: NM PA2011-0002) | |
Enumeration Date | 2010-06-25 |
Last Update Date | 2012-07-13 |