Healthcare Provider Details

I. General information

NPI: 1902485477
Provider Name (Legal Business Name): AMANDA LEIGH MABE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 06/30/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SUNSET BLVD N STE C
SUNSET BEACH NC
28468-4340
US

IV. Provider business mailing address

710 SUNSET BLVD N STE C
SUNSET BEACH NC
28468-4340
US

V. Phone/Fax

Practice location:
  • Phone: 336-613-4862
  • Fax:
Mailing address:
  • Phone: 910-795-1700
  • Fax: 910-661-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number231639
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5014325
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: