Provider Demographics
NPI:1639298136
Name:DEL RIO, AMANDA A (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 FAYETTEVILLE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6284
Mailing Address - Country:US
Mailing Address - Phone:919-942-4424
Mailing Address - Fax:910-942-4440
Practice Address - Street 1:6114 FAYETTEVILLE RD STE 109
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6284
Practice Address - Country:US
Practice Address - Phone:919-942-4424
Practice Address - Fax:919-942-4440
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC237909363L00000X
MA238131363LA2200X
NC5005005363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5005005OtherTAXONOMY
Q65497Medicare UPIN
NC5005005OtherTAXONOMY
MANP5294OtherBCBS MA
OHCOA.10751OtherTAXONOMY