Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2007011119 | MO |
N | 363L00000X | Nurse Practitioner | 4065P | KY |
NPI | 1003984048 |
---|---|
Provider Name | Elisa M Amspacher |
First Address | Columbia, MO 65205-7687 |
Second Address | Columbia, MO 65212-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 07/02/2008 |