Provider Demographics
NPI:1154833226
Name:DUNAWAY, AMANDA WORSHAM (AGACNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:WORSHAM
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:WORSHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:1 MERCADO ST STE 130
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7306
Mailing Address - Country:US
Mailing Address - Phone:970-247-1120
Mailing Address - Fax:970-241-1128
Practice Address - Street 1:1 MERCADO ST STE 130
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-247-1120
Practice Address - Fax:970-247-1128
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135625363LA2100X
COC-APN.0001424-C-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care