Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | LP-0000111 | DE |
NPI | 1003223371 |
---|---|
Provider Name | Mrs. Amanda Kathryn Marr |
First Address | Millville, DE 19967-6954 |
Second Address | Millville, DE 19967-6954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2014 |
Last Update Date | 17/07/2014 |