Healthcare Provider Details

I. General information

NPI: 1306763685
Provider Name (Legal Business Name): AMANDA QUILLEN MSN, APRN, ACCNS-N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KENYON MSN, APRN, ACCNS-N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 42ND AVE
CAPITOLA CA
95010-3503
US

IV. Provider business mailing address

1725 42ND AVE
CAPITOLA CA
95010-3503
US

V. Phone/Fax

Practice location:
  • Phone: 951-567-9057
  • Fax:
Mailing address:
  • Phone: 951-567-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SN0000X
TaxonomyNeonatal Clinical Nurse Specialist
License Number5263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: