Healthcare Provider Details

I. General information

NPI: 1174440515
Provider Name (Legal Business Name): AMANDA RUBENKONIG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 WHEEL HOUSE CT
WASHINGTON NC
27889-9720
US

IV. Provider business mailing address

PO BOX 222
WASHINGTON NC
27889-0222
US

V. Phone/Fax

Practice location:
  • Phone: 304-703-8212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number88741
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: