Provider Demographics
NPI:1326397084
Name:DUBOIS, AMANDA L (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELLIOT WAY
Mailing Address - Street 2:ELLIOT PEDIATRIC SURGERY
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-663-8393
Mailing Address - Fax:603-663-3493
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:ELLIOT PEDIATRIC SURGERY
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-8393
Practice Address - Fax:603-663-3493
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053614-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily