Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2016030402 | MO |
NPI | 1013440064 |
---|---|
Provider Name | Mrs. Amy Elizabeth Torres |
First Address | Rolla, MO 65401 |
Second Address | Rolla, MO 65401-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2017 |
Last Update Date | 21/08/2019 |