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General NPI Number Information
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NPI Number | 1366065542
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Entity Type | Individual
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Provider Name | AMANDA CRANDELL APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/22/2020
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 17-182B MIDDLE ROAD
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City | KURTISTOWN
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State | HI
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Zip | 96760
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Country | US
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Telephone | 979-264-5988
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 422
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City | KURTISTOWN
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State | HI
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Zip | 96760-0422
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Country | US
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Telephone | 979-264-5988
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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 | AP140180
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN-3247
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License Number State | HI
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