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General NPI Number Information
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NPI Number | 1639752595
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Entity Type | Individual
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Provider Name | AMANDA DESENNA CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 100 KENYON AVE
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City | SOUTH KINGSTOWN
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State | RI
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Zip | 02879-4216
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Country | US
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Telephone | 401-782-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 S WOODSTOCK ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2829
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Country | US
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Telephone | 401-527-2170
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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 | APRN02643
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License Number State | RI
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