Healthcare Provider Details

I. General information

NPI: 1629787288
Provider Name (Legal Business Name): AMANDA WREN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 RIVER PARK DR STE 200
SACRAMENTO CA
95815-4510
US

IV. Provider business mailing address

1435 RIVER PARK DR STE 200
SACRAMENTO CA
95815-4510
US

V. Phone/Fax

Practice location:
  • Phone: 916-286-7056
  • Fax:
Mailing address:
  • Phone: 916-286-7056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number723566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: