Healthcare Provider Details

I. General information

NPI: 1285516757
Provider Name (Legal Business Name): AMANDA LEE IVOS DNP, FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 US HIGHWAY 46 STE 300
WAYNE NJ
07470-6836
US

IV. Provider business mailing address

155 US HIGHWAY 46 STE 300
WAYNE NJ
07470-6836
US

V. Phone/Fax

Practice location:
  • Phone: 862-666-9285
  • Fax: 862-666-9287
Mailing address:
  • Phone: 862-666-9285
  • Fax: 862-666-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15363900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: