Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20163629 | PA |
NPI | 1043372881 |
---|---|
Provider Name | Amanda Conroy Naumann |
First Address | Philadelphia, PA 19146-1514 |
Second Address | Philadelphia, PA 19146-1514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 17/02/2017 |