Doctor Name: | MS. AMANDA J BALTIERRA |
NPI Number: | 1215996962 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | 0024167997 |
Business Practice Address: | 180 Grafton Ln Berryville, VA - 226112576 |
Business Phone Number: | 5409552400 |
Business Fax Number: | 5409559765 |
Mailing Address: | Po Box 112, 180 Grafton Lane BERRYVILLE |
State: | VA |
Postal Code: | 226110112 |
Phone Number: | 5409552400 |
Fax Number: | 5409559765 |
NPI Enumeration Date: | 03/21/2006 |
NPI Last Update Date: | 01/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024167997 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |