Provider Demographics
NPI:1801440102
Name:WOOD, AMANDA LEE ROSEMARY (DNP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEE ROSEMARY
Last Name:WOOD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3815 N SCHREIBER WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8434
Mailing Address - Country:US
Mailing Address - Phone:208-755-2804
Mailing Address - Fax:208-765-0277
Practice Address - Street 1:3815 N SCHREIBER WAY UNIT 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8434
Practice Address - Country:US
Practice Address - Phone:208-755-2804
Practice Address - Fax:208-765-0277
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60987586363L00000X
ID4661671363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner