Individual
AMANDA NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
5400 RAMSEY ST, FAYETTEVILLE, NC 28311-1420
(910) 630-7000
Mailing address
174 ALLEGIANCE ST, RAEFORD, NC 28376-6926
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL5844
FL
Other
Enumeration date
07/21/2018
Last updated
09/16/2024
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