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Individual

AMANDA LYNN IVERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
10101 PARK ROWE AVE, BATON ROUGE, LA 70810-1686
(225) 906-2999
Mailing address
330 CHAPEL LOOP, MANDEVILLE, LA 70471-2515

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
332139
LA

Other

Enumeration date
06/21/2022
Last updated
07/12/2022
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