| NPI | 1972588044 |
|---|---|
| Former Name | AMANDA KRISTINE FITZWATER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101240874) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 22499) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2006038229) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011239) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2015-06-24 |