Provider Demographics
NPI:1720744535
Name:RODELA, AMANDA N (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:RODELA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8100 WYOMING BLVD NE
Mailing Address - Street 2:SUITE M4 #308
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-5837
Mailing Address - Country:US
Mailing Address - Phone:505-633-4141
Mailing Address - Fax:
Practice Address - Street 1:4630 JEFFERSON LANE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-633-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2021-0101363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant