Provider Demographics
NPI:1063475846
Name:CABANISS, AMANDA T (RN, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:T
Last Name:CABANISS
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CRNP
Mailing Address - Street 1:1024 1ST ST N
Mailing Address - Street 2:CENTRAL ALABAMA ONCOLOGY, LLC
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8703
Mailing Address - Country:US
Mailing Address - Phone:205-664-4051
Mailing Address - Fax:205-664-4054
Practice Address - Street 1:1024 1ST ST N
Practice Address - Street 2:CENTRAL ALABAMA ONCOLOGY, LLC
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8703
Practice Address - Country:US
Practice Address - Phone:205-664-4051
Practice Address - Fax:205-664-4054
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1047753363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-047753OtherSTATE LICENSE
ALS20874Medicare UPIN