MEDICARE: MRS. AMANDA JILL WESTON FNP

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	363LF0000X	Family Nurse Practitioner	NP-1501A	ID

General Provider Information

NPI Number	:	1609278886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA JILL WESTON FNP

Provider Business Mailing Address
First Line	:	714 N COLLEGE RD
Second Line	:	ROME BUILDING, SUITE B
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5812
Country	:	US
Telephone Number	:	208-814-7180
Fax Number	:	208-814-7199

Provider Business Practice Location Address
First Line	:	714 N COLLEGE RD
Second Line	:	ROME BUILDING, SUITE B
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5812
Country	:	US
Telephone Number	:	208-814-7180
Fax Number	:	208-814-7199

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

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	09/19/2014

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