Provider Demographics
NPI:1811591472
Name:GIDEON, AMANDA ANN (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:GIDEON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7135
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88241-7135
Mailing Address - Country:US
Mailing Address - Phone:575-441-0855
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9100
Practice Address - Country:US
Practice Address - Phone:575-492-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56441163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency