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General NPI Number Information
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NPI Number | 1902485477
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Entity Type | Individual
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Provider Name | AMANDA LEIGH MABE NP
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Gender | Female
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Dates
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Enumeration Date | 04/03/2021
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 710 SUNSET BLVD N STE C
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City | SUNSET BEACH
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State | NC
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Zip | 28468-4340
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Country | US
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Telephone | 336-613-4862
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Fax |
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Provider Business Mailing Address
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Address Line | 710 SUNSET BLVD N STE C
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City | SUNSET BEACH
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State | NC
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Zip | 28468-4340
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Country | US
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Telephone | 910-795-1700
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Fax | 910-661-0683
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 5014325
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 231639
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License Number State | NC
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