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General NPI Number Information
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NPI Number | 1164006235
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Entity Type | Individual
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Provider Name | AMANDA LEE JOHN TITUS RN
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Gender | Female
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 10535 HOSPITAL WAY
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City | MATHER
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State | CA
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Zip | 95655-4200
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Country | US
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Telephone | 916-843-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 S 50TH AVE APT 10
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City | WAUSAU
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State | WI
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Zip | 54401-8654
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Country | US
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Telephone | 701-891-8216
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | R36608
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License Number State | ND
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