Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402158 | NY |
NPI | 1023546843 |
---|---|
Provider Name | Amanda L Hance |
First Address | Fort Drum, NY 13602-5438 |
Second Address | Fort Drum, NY 13602-5438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 13/08/2020 |