Provider Demographics
NPI:1609278886
Name:WESTON, AMANDA JILL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JILL
Last Name:WESTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:714 N COLLEGE RD
Mailing Address - Street 2:ROME BUILDING, SUITE B
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5812
Mailing Address - Country:US
Mailing Address - Phone:208-814-7180
Mailing Address - Fax:208-814-7199
Practice Address - Street 1:714 N COLLEGE RD
Practice Address - Street 2:ROME BUILDING, SUITE B
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5812
Practice Address - Country:US
Practice Address - Phone:208-814-7180
Practice Address - Fax:208-814-7199
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1501A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily