Healthcare Provider Details

I. General information

NPI: 1316488083
Provider Name (Legal Business Name): AMANDA LEVEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 STATE ST
BISMARCK ND
58503-0669
US

IV. Provider business mailing address

1212 SALMON ST
BISMARCK ND
58503-9073
US

V. Phone/Fax

Practice location:
  • Phone: 701-221-9152
  • Fax:
Mailing address:
  • Phone: 701-202-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR33359
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR38359
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: