=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720693138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA DAHLGREN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2020
-----------------------------------------------------
Last Update Date | 11/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 MAIN ST
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04073-3680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-850-5744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 US HIGHWAY 1 BYP UNIT 102
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-7105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-410-6700
-----------------------------------------------------
Fax | 603-319-8308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 090946-23
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP231098
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------