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General NPI Number Information
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NPI Number | 1225388028
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Entity Type | Individual
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Provider Name | AMANDA DEE ROBY N.P.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 850 W IRONWOOD DR # 500
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4903
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Country | US
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Telephone | 208-667-1376
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Fax | 208-292-0873
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Provider Business Mailing Address
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Address Line | 850 W IRONWOOD DR # 500
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4903
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Country | US
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Telephone | 208-667-1376
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Fax | 208-292-0873
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 24686A
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License Number State | ID
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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 | 60310022
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License Number State | WA
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