Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043561491 |
---|---|
Provider Name | Miss Amanda Michele Hedges |
First Address | Las Vegas, NV 89117-5303 |
Second Address | Las Vegas, NV 89102-1942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 18/07/2019 |