Healthcare Provider Details

I. General information

NPI: 1952893893
Provider Name (Legal Business Name): AMANDA A TEMPLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109-4597
US

IV. Provider business mailing address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109-4597
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax:
Mailing address:
  • Phone: 505-883-2574
  • Fax: 505-883-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-03597
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: