Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP145451 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP145451 | TX |
NPI | 1023630423 |
---|---|
Provider Name | Mrs. Courtney Amanda Adamski |
First Address | Sound Beach, NY 11789-1316 |
Second Address | San Antonio, TX 78229-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2020 |
Last Update Date | 08/05/2020 |