Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3007039 | KY |
NPI | 1003194820 |
---|---|
Provider Name | Amanda Danielle Saccone |
First Address | Louisville, KY 40218-4817 |
Second Address | Louisville, KY 40218-1921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2011 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100178700 | (05) | KY |