Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | Q8901 | TX |
NPI | 1003159856 |
---|---|
Provider Name | Amanda Nicole Hartman |
First Address | Malvern, PA 19355-0746 |
Second Address | Canyon, TX 79015-3058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2013 |
Last Update Date | 27/12/2019 |