Provider Demographics
NPI:1285392217
Name:MATHENY, AMANDA MYSHELE CANUPP (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MYSHELE CANUPP
Last Name:MATHENY
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSSIPEE TRL E STE 1153
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6421
Mailing Address - Country:US
Mailing Address - Phone:207-661-4850
Mailing Address - Fax:
Practice Address - Street 1:111 OSSIPEE TRL E STE 1153
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6421
Practice Address - Country:US
Practice Address - Phone:207-661-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211483363LF0000X
NH086699-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily