Provider Demographics
NPI:1164090882
Name:PASCUAL, AMANDA SARAH MAHINALANI (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SARAH MAHINALANI
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 DANA PT APT 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-9151
Mailing Address - Country:US
Mailing Address - Phone:518-698-8749
Mailing Address - Fax:
Practice Address - Street 1:45825 E STATE HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-9330
Practice Address - Country:US
Practice Address - Phone:719-549-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1653927163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse