Provider Demographics
NPI:1346975901
Name:COMP, AMANDA MARY (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARY
Last Name:COMP
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 1:86227 DEBBIE RD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2975
Mailing Address - Country:US
Mailing Address - Phone:414-418-5357
Mailing Address - Fax:
Practice Address - Street 1:295 LAFAYETTE ST # 7TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2701
Practice Address - Country:US
Practice Address - Phone:414-418-5357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61271056163W00000X
FLRN9529728163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse