Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP10182 | LA |
NPI | 1710440466 |
---|---|
Provider Name | Amanda Smith Martinez |
First Address | Lafayette, LA 70501-2837 |
Second Address | Lafayette, LA 70501-2837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 22/02/2021 |