Provider Demographics
NPI:1477376697
Name:DILLEY, AMANDA JOSEPHINE (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOSEPHINE
Last Name:DILLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:JOSEPHINE
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1820 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2605
Mailing Address - Country:US
Mailing Address - Phone:956-285-4541
Mailing Address - Fax:
Practice Address - Street 1:1700 E SAUNDERS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5474
Practice Address - Country:US
Practice Address - Phone:956-796-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX866687163WG0000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice