Provider Demographics
NPI:1457178733
Name:MUGGLE, AMANDA MAY (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MAY
Last Name:MUGGLE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6955
Mailing Address - Country:US
Mailing Address - Phone:401-743-9033
Mailing Address - Fax:
Practice Address - Street 1:20 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6955
Practice Address - Country:US
Practice Address - Phone:401-743-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN04208364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health