MEDICARE: AMANDA NICHOLE ELEY RN, CCRN, FNP STUDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	0001265926	VA

General Provider Information

NPI Number	:	1174415087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NICHOLE ELEY RN, CCRN, FNP STUDEN

Provider Business Mailing Address
First Line	:	266 CHURCH ST
Second Line	:
City	:	BLYTHE
State	:	GA
Zip	:	30805-3408
Country	:	US
Telephone Number	:	210-473-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E HOSPITAL RD
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-0000
Country	:	US
Telephone Number	:	210-473-8162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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