Healthcare Provider Details

I. General information

NPI: 1477169381
Provider Name (Legal Business Name): AMANDA FARRIS RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALDWELL RD
AUGUSTA ME
04330-5739
US

IV. Provider business mailing address

11 CALDWELL RD
AUGUSTA ME
04330-5739
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-2136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN66487
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: