Healthcare Provider Details

I. General information

NPI: 1992590228
Provider Name (Legal Business Name): AMANDA J FRUGE AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 S EASTERN AVE STE 403
HENDERSON NV
89052-3908
US

IV. Provider business mailing address

700 SHADOW LN STE 240
LAS VEGAS NV
89106-4158
US

V. Phone/Fax

Practice location:
  • Phone: 702-754-0622
  • Fax: 702-476-2161
Mailing address:
  • Phone: 702-384-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number883491
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number883491
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: