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NPI Code Detail

MEDICARE: AMANDA FRALE RN

MEDICARE: AMANDA FRALE RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN.1628049CO

General Provider Information

NPI Number : 1679055404
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA FRALE RN
Provider Business Mailing Address
First Line : 2212 VERMONT DR APT E102
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-6179
Country : US
Telephone Number : 970-319-2426
Fax Number :
Provider Business Practice Location Address
First Line : 151 W LAKE ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-4111
Country : US
Telephone Number : 970-491-7121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 08/29/2018

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