Healthcare Provider Details

I. General information

NPI: 1801440102
Provider Name (Legal Business Name): AMANDA LEE ROSEMARY WOOD DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RANGEL

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 N SCHREIBER WAY UNIT 101
COEUR D ALENE ID
83815-8434
US

IV. Provider business mailing address

3815 N SCHREIBER WAY UNIT 101
COEUR D ALENE ID
83815-8434
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-2804
  • Fax: 208-765-0277
Mailing address:
  • Phone: 208-755-2804
  • Fax: 208-765-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60987586
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4661671
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: