Provider Demographics
NPI:1770009565
Name:BLUE, AMANDA ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:BLUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 REGIMENTAL LN
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-3123
Mailing Address - Country:US
Mailing Address - Phone:843-270-4426
Mailing Address - Fax:
Practice Address - Street 1:710 JOHNNIE DODDS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3045
Practice Address - Country:US
Practice Address - Phone:843-800-1303
Practice Address - Fax:888-316-7714
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC63137163WS0200X
SC28984363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool