Provider Demographics
NPI:1063197408
Name:MADERIA, AMANDA CATHERINE (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CATHERINE
Last Name:MADERIA
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 MISTY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9670
Mailing Address - Country:US
Mailing Address - Phone:364-731-3743
Mailing Address - Fax:
Practice Address - Street 1:111 GATEWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2999
Practice Address - Country:US
Practice Address - Phone:336-713-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC271039163W00000X
NC5018473363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse