Provider Demographics
NPI:1235822636
Name:SMITH, AMANDA L (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:SMITH
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 1:6215 BLACKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-6806
Mailing Address - Country:US
Mailing Address - Phone:775-544-9024
Mailing Address - Fax:
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV68753163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse