Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024172684 | VA |
NPI | 1033592746 |
---|---|
Provider Name | Angela Susan Amas |
First Address | Fairfax, VA 22031-4512 |
Second Address | Fairfax, VA 22031-4512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 11/09/2015 |