Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R863756 | MS |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R41616 | ND |
NPI | 1003046616 |
---|---|
Provider Name | Dr. Amanda Leigh Perry |
First Address | Cooperstown, ND 58425-9264 |
Second Address | Cooperstown, ND 58425-9264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 09/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07736054 | (05) | MS |