Provider Demographics
NPI:1033925169
Name:FAITH, AMANDA LEA (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
Last Name:FAITH
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 1:701 FOX NEST CIR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9396
Mailing Address - Country:US
Mailing Address - Phone:318-455-1847
Mailing Address - Fax:
Practice Address - Street 1:701 FOX NEST CIR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9396
Practice Address - Country:US
Practice Address - Phone:318-455-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN138647163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty