Healthcare Provider Details

I. General information

NPI: 1790200749
Provider Name (Legal Business Name): AMANDA COMAI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 12/11/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PENNACOOK ST
MANCHESTER NH
03104-3554
US

IV. Provider business mailing address

784 HERCULES DR STE 110
COLCHESTER VT
05446-8049
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-7321
  • Fax:
Mailing address:
  • Phone: 802-448-9755
  • Fax: 802-448-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number101.0134359
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number07639823
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: