MEDICARE: AMANDA VIETTI 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	868841	NV

General Provider Information

NPI Number	:	1699475152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA VIETTI APRN

Provider Business Mailing Address
First Line	:	5155 CAMINO AL NORTE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2359
Country	:	US
Telephone Number	:	702-707-7246
Fax Number	:	702-550-2010

Provider Business Practice Location Address
First Line	:	5155 CAMINO AL NORTE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2359
Country	:	US
Telephone Number	:	702-707-7246
Fax Number	:

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	12/03/2024

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