Provider Demographics
NPI:1497212377
Name:HRYCAJ, AMANDA LAUREN (FNP-BC, AG-ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LAUREN
Last Name:HRYCAJ
Suffix:
Gender:F
Credentials:FNP-BC, AG-ACNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LAUREN
Other - Last Name:FIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4216 HIGHWAY 144
Mailing Address - Street 2:
Mailing Address - City:WELDONA
Mailing Address - State:CO
Mailing Address - Zip Code:80653-9105
Mailing Address - Country:US
Mailing Address - Phone:970-571-0469
Mailing Address - Fax:
Practice Address - Street 1:1000 LINCOLN ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3290
Practice Address - Country:US
Practice Address - Phone:970-542-4390
Practice Address - Fax:970-542-4913
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994486-NP363LA2100X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0994486-NPOtherNURSING LICENSE