Provider Demographics
NPI:1952706897
Name:GOLDBERG, AMANDA RICHARD (MN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RICHARD
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MN, APRN, FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RUTH
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 WALL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7107
Mailing Address - Country:US
Mailing Address - Phone:504-393-2273
Mailing Address - Fax:504-393-2744
Practice Address - Street 1:148 WALL BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7107
Practice Address - Country:US
Practice Address - Phone:504-393-2273
Practice Address - Fax:504-393-2744
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN123165163W00000X
LAAP08005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse