Healthcare Provider Details

I. General information

NPI: 1447199484
Provider Name (Legal Business Name): AMANDA LEIGH GOW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MAIN ST SE
LOS LUNAS NM
87031-7416
US

IV. Provider business mailing address

944 LUNA HILL AVE SE
LOS LUNAS NM
87031-6254
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-8430
  • Fax:
Mailing address:
  • Phone: 505-866-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-72227
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: