Provider Demographics
NPI:1437778933
Name:MANDILE, AMY MICHELLE (DNP-FNP-C)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
Last Name:MANDILE
Suffix:
Gender:F
Credentials:DNP-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 E VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6920
Mailing Address - Country:US
Mailing Address - Phone:602-323-8202
Mailing Address - Fax:
Practice Address - Street 1:8426 E PAMPA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-1562
Practice Address - Country:US
Practice Address - Phone:480-392-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP240334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily