Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | A005720 | AR |
N | 363LG0600X | Nurse Practitioner - Gerontology | A005720 | AR |
NPI | 1043787070 |
---|---|
Provider Name | Ms. Amanda Ruth Guise-Mcdonough |
First Address | Little Rock, AR 72207-4724 |
Second Address | Little Rock, AR 72207-4724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2018 |
Last Update Date | 29/10/2018 |