Provider Demographics
NPI:1336332287
Name:LUNDY, AMANDA D (RN SFA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:D
Last Name:LUNDY
Suffix:
Gender:F
Credentials:RN SFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9037
Mailing Address - Country:US
Mailing Address - Phone:505-599-8762
Mailing Address - Fax:505-599-8796
Practice Address - Street 1:1390 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9037
Practice Address - Country:US
Practice Address - Phone:505-599-8762
Practice Address - Fax:505-599-8796
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR52751163WX0800X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47522Medicaid
NM10035068OtherLOVELACE
NMR52751OtherNEW MEXICO BOARD OF NURSI
NM00NM006H20OtherBCBS