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General NPI Number Information
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NPI Number | 1144568767
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Entity Type | Individual
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Provider Name | AMANDA S WILES NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 904 5TH AVE NE
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City | JAMESTOWN
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State | ND
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Zip | 58401-3437
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Country | US
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Telephone | 701-253-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2168
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City | FARGO
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State | ND
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Zip | 58107-2168
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Country | US
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Telephone | 701-234-2119
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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 | 2013001306
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R39620
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | R39620
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License Number State | ND
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