Healthcare Provider Details

I. General information

NPI: 1710714258
Provider Name (Legal Business Name): AMANDA ROSE GRESSEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 E WILLIAMS FIELD RD STE 111
GILBERT AZ
85295-0736
US

IV. Provider business mailing address

3030 N CENTRAL AVE STE 1200
PHOENIX AZ
85012-2745
US

V. Phone/Fax

Practice location:
  • Phone: 480-795-1515
  • Fax:
Mailing address:
  • Phone: 480-607-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number315555
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number152882
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: