Provider Demographics
NPI:1982873170
Name:NELSON, AMANDA RENAE (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RENAE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 FERN LOOP
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-9806
Mailing Address - Country:US
Mailing Address - Phone:509-967-3955
Mailing Address - Fax:509-783-6611
Practice Address - Street 1:5446 FERN LOOP
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-9806
Practice Address - Country:US
Practice Address - Phone:509-967-3955
Practice Address - Fax:509-783-6611
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00144373163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant