Provider Demographics
NPI:1952707184
Name:WARD, AMANDA LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:WARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:ID
Mailing Address - Zip Code:83311-0043
Mailing Address - Country:US
Mailing Address - Phone:208-312-9740
Mailing Address - Fax:208-678-0910
Practice Address - Street 1:950S 1325E
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:ID
Practice Address - Zip Code:83311
Practice Address - Country:US
Practice Address - Phone:208-312-9740
Practice Address - Fax:208-678-0910
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1514A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily