Provider Demographics
NPI:1083612147
Name:TENHULZEN, AMANDA B (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:B
Last Name:TENHULZEN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1438
Mailing Address - Country:US
Mailing Address - Phone:518-458-2000
Mailing Address - Fax:518-458-1524
Practice Address - Street 1:2 PALISADES DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1438
Practice Address - Country:US
Practice Address - Phone:518-458-2000
Practice Address - Fax:518-458-1524
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304140363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02659483Medicaid
NYQ57825Medicare UPIN
NY02659483Medicaid