Provider Demographics
NPI:1477719433
Name:DRAPER, AMANDA M (NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:DRAPER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-6000
Mailing Address - Fax:208-302-6055
Practice Address - Street 1:323 E RIVERSIDE DRIVE
Practice Address - Street 2:STE 224
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83616-6815
Practice Address - Country:US
Practice Address - Phone:208-302-6000
Practice Address - Fax:208-302-6055
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP873A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health