Healthcare Provider Details

I. General information

NPI: 1104136696
Provider Name (Legal Business Name): AMY G FAMINI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 STONY CIR STE 1600
SANTA ROSA CA
95401-9520
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-7800
  • Fax: 707-573-5420
Mailing address:
  • Phone: 707-541-7800
  • Fax: 707-573-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number683686
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberATP-000307
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number683686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: