Individual
AMANDA HATATHLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HIGHWAY 264 MILE POST 388, POLACCA, AZ 86042
(928) 737-6000
Mailing address
PO BOX 801, POLACCA, AZ 86042-0801
(520) 213-6962
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
2517199
AZ
Other
Enumeration date
07/11/2023
Last updated
07/11/2023
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