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General NPI Number Information
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NPI Number | 1649630039
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Entity Type | Individual
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Provider Name | AMANDA MARIE CIANCIOLO RN
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Gender | Female
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1045 S LENZNER AVE
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-4880
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Country | US
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Telephone | 520-515-2937
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 S LENZNER AVE
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-4880
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Country | US
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Telephone | 520-533-9147
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Fax | 520-533-5328
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LP049919
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 232401
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License Number State | AZ
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