Provider Demographics
NPI:1275106296
Name:LEPORI, AMANDA MCKENZIE (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MCKENZIE
Last Name:LEPORI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840857
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0857
Mailing Address - Country:US
Mailing Address - Phone:725-204-4632
Mailing Address - Fax:702-805-0307
Practice Address - Street 1:7160 RAFAEL RIVERA WAY STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-5395
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:702-209-2064
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN86368163WC0200X
NV850873367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty