Healthcare Provider Details

I. General information

NPI: 1205281680
Provider Name (Legal Business Name): AMANDA MEADOWS BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 WALNUT LN
YORBA LINDA CA
92886-4934
US

IV. Provider business mailing address

5455 WALNUT LN
YORBA LINDA CA
92886-4934
US

V. Phone/Fax

Practice location:
  • Phone: 925-783-3338
  • Fax:
Mailing address:
  • Phone: 925-783-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number798871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: