Healthcare Provider Details

I. General information

NPI: 1972891273
Provider Name (Legal Business Name): AMANDA MARIE CHRISTIAN APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 PENNSYLVANIA AVE STE 300
FAIRFIELD CA
94533-3550
US

IV. Provider business mailing address

4500 BUSINESS CENTER DR
FAIRFIELD CA
94534-6888
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN001324
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236543
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN001324
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: