Healthcare Provider Details

I. General information

NPI: 1437954179
Provider Name (Legal Business Name): AMANDA JANE BLACK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JANE CUTTS

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE FL 4
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

4043 38TH AVE SW
SEATTLE WA
98126-2430
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax: 206-744-8520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61624918
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: