Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | APN0991259NP | CO |
Y | 363LP2300X | Nurse Practitioner - Primary Care | APN-0991259 | CO |
NPI | 1023425386 |
---|---|
Provider Name | Mrs. Amanda C Fadenrecht |
First Address | Pueblo West, CO 81007-5123 |
Second Address | Pueblo West, CO 81007-5123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2014 |
Last Update Date | 12/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APN0991259NP | STATE LICENSE (01) | CO |