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General NPI Number Information
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NPI Number | 1134731888
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Entity Type | Individual
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Provider Name | AMANDA MCBRIDE FNP
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Gender | Female
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 530 UNION AVE
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City | FAIRFIELD
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State | CA
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Zip | 94533-6367
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Country | US
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Telephone | 707-784-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 530 UNION AVE
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City | FAIRFIELD
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State | CA
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Zip | 94533-6367
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Country | US
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Telephone | 707-784-7150
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Fax |
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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 | 95015560
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License Number State | CA
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