Provider Demographics
NPI:1104680081
Name:FERNANDEZ, AMANDA ARUE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ARUE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WYMAN ST UNIT 10
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3157
Mailing Address - Country:US
Mailing Address - Phone:603-986-0851
Mailing Address - Fax:
Practice Address - Street 1:2 E MAIN ST # 2
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:NH
Practice Address - Zip Code:03278-4421
Practice Address - Country:US
Practice Address - Phone:603-456-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053241-21163W00000X
NH053241-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse