Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 363LP0200X | LA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP09531 | LA |
NPI | 1043726557 |
---|---|
Provider Name | Mrs. Amanda Gammel James |
First Address | Deville, LA 71328-0197 |
Second Address | Winnfield, LA 71483-3463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 17/05/2021 |