Healthcare Provider Details

I. General information

NPI: 1700611894
Provider Name (Legal Business Name): AMANDA WHITMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9428
US

IV. Provider business mailing address

194 SUTTON RD
LA GRANGE NC
28551-9100
US

V. Phone/Fax

Practice location:
  • Phone: 919-734-1779
  • Fax:
Mailing address:
  • Phone: 919-223-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020694
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: