Provider Demographics
NPI:1578224457
Name:STOCKWELL, AMANDA LORRAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LORRAINE
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-204
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5391
Mailing Address - Country:US
Mailing Address - Phone:315-521-2455
Mailing Address - Fax:
Practice Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5391
Practice Address - Country:US
Practice Address - Phone:315-521-2455
Practice Address - Fax:602-926-7251
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF06210238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily