Provider Demographics
NPI:1669673604
Name:FERENC, AMANDA LYNN (LPN)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LYNN
Last Name:FERENC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 CANNON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-3549
Mailing Address - Country:US
Mailing Address - Phone:302-841-2498
Mailing Address - Fax:
Practice Address - Street 1:6755 CANNON RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:DE
Practice Address - Zip Code:19933-3549
Practice Address - Country:US
Practice Address - Phone:302-841-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0009704164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse