Provider Demographics
NPI:1275964892
Name:EASTMAN, AMANDA J (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:155 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-2038
Practice Address - Country:US
Practice Address - Phone:978-345-1919
Practice Address - Fax:978-342-6240
Is Sole Proprietor?:No
Enumeration Date:2013-12-07
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX751098363LF0000X
MARN2300387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily