Provider Demographics
NPI:1740829415
Name:NAHAS-WILSON, AMANDA MARIE (APN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:NAHAS-WILSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GALLANT FOX LN
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8009
Mailing Address - Country:US
Mailing Address - Phone:609-992-5251
Mailing Address - Fax:
Practice Address - Street 1:631 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2483
Practice Address - Country:US
Practice Address - Phone:609-653-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00986600363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care