Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1265682728 |
---|---|
Provider Name | Mrs. Amanda Wallace Street |
First Address | Asheville, NC 28801-4608 |
Second Address | Asheville, NC 28801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2008 |
Last Update Date | 11/07/2018 |