=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649699331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA NAFF RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2014
-----------------------------------------------------
Last Update Date | 04/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 GUFFEY ST
-----------------------------------------------------
City | CELINA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38551-4089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-243-2651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 GUFFEY ST
-----------------------------------------------------
City | CELINA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38551-4089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-243-2651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 1139098
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------