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General NPI Number Information
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NPI Number | 1619864089
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Entity Type | Individual
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Provider Name | AMANDA RENEE PACHECO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 2515 RIDGE RUNNER RD
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City | LAS VEGAS
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State | NM
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Zip | 87701-4972
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Country | US
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Telephone | 505-434-0119
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 46
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City | SERAFINA
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State | NM
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Zip | 87569-0046
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Country | US
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Telephone | 505-426-7575
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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 | 84599
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License Number State | NM
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