Healthcare Provider Details

I. General information

NPI: 1467091280
Provider Name (Legal Business Name): AMANDA LEOLA EGAN POIRIER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HOSPITAL AVE. SUITE #302
NORTH ADAMS MA
01247
US

IV. Provider business mailing address

77 HOSPITAL AVE. SUITE #302
NORTH ADAMS MA
01247
US

V. Phone/Fax

Practice location:
  • Phone: 413-663-8365
  • Fax: 413-662-2363
Mailing address:
  • Phone: 413-663-8365
  • Fax: 413-662-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2316497
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2319497
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: