Provider Demographics
NPI:1124649546
Name:AMADOR, BLANCA ROSA (RN)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:ROSA
Last Name:AMADOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2961
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8900
Mailing Address - Country:US
Mailing Address - Phone:214-762-8922
Mailing Address - Fax:
Practice Address - Street 1:205 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5422
Practice Address - Country:US
Practice Address - Phone:972-393-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644281163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management