Healthcare Provider Details

I. General information

NPI: 1770915886
Provider Name (Legal Business Name): AMANDA GAIL HAMES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

103 SHEFFIELD RD
JACKSONVILLE NC
28546-8427
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-3665
  • Fax:
Mailing address:
  • Phone: 910-545-6730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number230833
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: