Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R72680 | AZ |
Y | 2080P0202X | Pediatric Cardiologist | 27822 | NE |
NPI | 1003195934 |
---|---|
Provider Name | Dr. Amanda Marshall |
First Address | Omaha, NE 68114-4113 |
Second Address | Omaha, NE 68114-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 29/08/2014 |