=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104449594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA K. NODDINGS NAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2020
-----------------------------------------------------
Last Update Date | 05/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6025 N ASSEMBLY ST
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99205-7674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-326-8282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 E PIPER GLEN CT
-----------------------------------------------------
City | COLBERT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99005-9202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-218-6064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | NC60206882
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------