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Individual
AMANDA PRUSAK
Active
Individual
AMANDA PRUSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, ATC, LAT
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2310
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200014240
BOARD OF CERTIFICATION
—
01
—
2310
NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS
NC
Enumeration date
01/09/2014
Last updated
04/05/2019
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