Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP60620377 | WA |
NPI | 1033575113 |
---|---|
Provider Name | Amanda Jane Holen |
First Address | Kent, WA 98030 |
Second Address | Kent, WA 98031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2016 |
Last Update Date | 26/02/2016 |