| NPI | 1982011979 |
|---|---|
| Former Name | AMANDA HALVERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R34824) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND R34824) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: ND R34824) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2019-08-06 |