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General NPI Number Information
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NPI Number | 1356959142
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Entity Type | Individual
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Provider Name | AMANDA LI NELSON NP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 367 BAY RIDGE PKWY # 1
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City | BROOKLYN
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State | NY
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Zip | 11209-3177
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Country | US
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Telephone | 718-630-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 220 GREEN VALLEY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-1825
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Country | US
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Telephone | 718-490-0467
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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 | 342700
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License Number State | NY
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