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General NPI Number Information
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NPI Number | 1104136696
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Entity Type | Individual
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Provider Name | AMY G FAMINI NP
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Gender | Female
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 131 STONY CIR STE 1600
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City | SANTA ROSA
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State | CA
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Zip | 95401-9520
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Country | US
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Telephone | 707-541-7800
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Fax | 707-573-5420
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 707-541-7800
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Fax | 707-573-5420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ATP-000307
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 683686
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 683686
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License Number State | CA
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