Provider Demographics
NPI:1083198147
Name:SAWIRES YAGER, AMANDA (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SAWIRES YAGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28360 OLD TOWN FRONT ST
Mailing Address - Street 2:#544
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-7023
Mailing Address - Country:US
Mailing Address - Phone:617-331-0385
Mailing Address - Fax:
Practice Address - Street 1:28360 OLD TOWN FRONT ST
Practice Address - Street 2:#544
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92593-7023
Practice Address - Country:US
Practice Address - Phone:617-331-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily