Provider Demographics
NPI:1861814824
Name:EMERY, AMANDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:EMERY
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 1:1475 S SINOVA AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-7388
Mailing Address - Country:US
Mailing Address - Phone:480-917-0117
Mailing Address - Fax:480-917-6923
Practice Address - Street 1:1475 S SINOVA AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-7388
Practice Address - Country:US
Practice Address - Phone:480-917-0117
Practice Address - Fax:480-917-6923
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ180390163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse