Healthcare Provider Details

I. General information

NPI: 1780383661
Provider Name (Legal Business Name): AMANDA DANIELLE O'SICKEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMANDA DANIELLE DOUGLAS

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

6788 AUGUSTA HILLS DR NE
RIO RANCHO NM
87144-8647
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2156
  • Fax:
Mailing address:
  • Phone: 505-604-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number72277
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number72277
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: