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General NPI Number Information
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NPI Number | 1225659394
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Entity Type | Individual
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Provider Name | AMANDA LYNN WILBURN FNP
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Gender | Female
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 212 MAIN ST
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City | CONWAY
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State | SC
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Zip | 29526-5129
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Country | US
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Telephone | 843-488-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 5504 PLANTERSVILLE PL
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-3671
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Country | US
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Telephone | 843-796-0830
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 29596
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License Number State | SC
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