Healthcare Provider Details

I. General information

NPI: 1083212195
Provider Name (Legal Business Name): AMANDA TORGERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PROSPECT DR
GLENDIVE MT
59330-1999
US

IV. Provider business mailing address

8343 HAWK EYE RD NW
ALBUQUERQUE NM
87120-3788
US

V. Phone/Fax

Practice location:
  • Phone: 406-345-3306
  • Fax: 406-345-3312
Mailing address:
  • Phone: 303-819-8954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number176580
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-60966
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60966
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: