Healthcare Provider Details

I. General information

NPI: 1366169880
Provider Name (Legal Business Name): AMANDA GULBRANDSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 ROUTE 32
ROSENDALE NY
12472-9660
US

IV. Provider business mailing address

578 5TH AVE APT 3B
BROOKLYN NY
11215-7522
US

V. Phone/Fax

Practice location:
  • Phone: 845-658-9476
  • Fax:
Mailing address:
  • Phone: 845-321-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359507
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number673208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: