Provider Demographics
NPI:1023425386
Name:FADENRECHT, AMANDA C (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:C
Last Name:FADENRECHT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S PURCELL BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5123
Mailing Address - Country:US
Mailing Address - Phone:719-281-9587
Mailing Address - Fax:855-593-6512
Practice Address - Street 1:141 S PURCELL BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5123
Practice Address - Country:US
Practice Address - Phone:719-281-9587
Practice Address - Fax:855-593-6512
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN-0991259363LP2300X
COAPN0991259NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN0991259NPOtherSTATE LICENSE