Healthcare Provider Details

I. General information

NPI: 1477792869
Provider Name (Legal Business Name): AMANDA M. CRIM PINHEIRO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA M. FURTADO, HODGE

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S MAIN ST STE C
LAS CRUCES NM
88005-3797
US

IV. Provider business mailing address

4112 MEADOW SAGE PL
LAS CRUCES NM
88011-4382
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-8378
  • Fax:
Mailing address:
  • Phone: 417-671-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2023-0313
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2009001274
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-2081
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: