MEDICARE: AMANDA MARIE CHRISTIAN APRN, CNM

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	367A00000X	Advanced Practice Midwife	236543	CA
2	367A00000X	Advanced Practice Midwife	APRN001324	NV
3	363L00000X	Nurse Practitioner	APRN001324	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	12401844	OTHER		CAQH

General Provider Information

NPI Number	:	1972891273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE CHRISTIAN APRN, CNM

Provider Business Mailing Address
First Line	:	4500 BUSINESS CENTER DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-6888
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 PENNSYLVANIA AVE STE 300
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3550
Country	:	US
Telephone Number	:	707-646-4100
Fax Number	:

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

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	02/25/2026

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