Provider Demographics
NPI:1790467165
Name:VANDLING, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:VANDLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 WEST RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-5303
Mailing Address - Country:US
Mailing Address - Phone:505-662-4351
Mailing Address - Fax:
Practice Address - Street 1:3917 WEST RD STE 150
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-5303
Practice Address - Country:US
Practice Address - Phone:505-662-4351
Practice Address - Fax:505-662-2932
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-79935163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse