Healthcare Provider Details

I. General information

NPI: 1629776307
Provider Name (Legal Business Name): AMANDA ELAINE SAVARESE AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

V. Phone/Fax

Practice location:
  • Phone: 919-828-0890
  • Fax:
Mailing address:
  • Phone: 919-828-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5017722
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5017722
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5017722
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: