Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP145615 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP145615 | TX |
NPI | 1275153215 |
---|---|
Provider Name | Amanda Danielle Fridley |
First Address | Pearland, TX 77581-6736 |
Second Address | Galveston, TX 77555-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2020 |
Last Update Date | 20/04/2020 |