MEDICARE: AMANDA LEIGH GOW RN

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	163WS0200X	School Registered Nurse	RN-72227	NM

General Provider Information

NPI Number	:	1447199484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEIGH GOW RN

Provider Business Mailing Address
First Line	:	944 LUNA HILL AVE SE
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-6254
Country	:	US
Telephone Number	:	505-866-8430
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 MAIN ST SE
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-7416
Country	:	US
Telephone Number	:	505-866-8430
Fax Number	:

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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