Healthcare Provider Details

I. General information

NPI: 1629365614
Provider Name (Legal Business Name): AMANDA NICOLE NEAL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 12TH STREET EXT
PRINCETON WV
24740-2352
US

IV. Provider business mailing address

118 12TH STREET EXT
PRINCETON WV
24740-2352
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-7936
  • Fax: 304-487-7835
Mailing address:
  • Phone: 304-487-7936
  • Fax: 304-487-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63103
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: