Doctor Name: | MRS. AMANDA C FADENRECHT |
NPI Number: | 1023425386 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | APN0991259NP |
Business Practice Address: | 3676 Parker Blvd Suite 260 Pueblo, CO - 810082212 |
Business Phone Number: | 7195532201 |
Business Fax Number: | 7195532224 |
Mailing Address: | Po Box 9000, PUEBLO |
State: | CO |
Postal Code: | 810089000 |
Phone Number: | 7195532201 |
Fax Number: | 7195532224 |
NPI Enumeration Date: | 07/18/2014 |
NPI Last Update Date: | 07/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN0991259NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |