MEDICARE: AMANDA J. FUCCI APRN

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
1	363LF0000X	Family Nurse Practitioner	057371-23	NH
2	363L00000X	Nurse Practitioner	057371-23	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	057371-23	OTHER	NH	APRN MEDICAL LICENSE

General Provider Information

NPI Number	:	1699255539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA J. FUCCI APRN

Provider Business Mailing Address
First Line	:	27 NEW DURHAM RD
Second Line	:
City	:	ALTON
State	:	NH
Zip	:	03809-4917
Country	:	US
Telephone Number	:	603-875-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 NEW DURHAM RD
Second Line	:
City	:	ALTON
State	:	NH
Zip	:	03809-4917
Country	:	US
Telephone Number	:	603-875-6151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	04/16/2021

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