Provider Demographics
NPI:1225388028
Name:ROBY, AMANDA DEE (NP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:DEE
Last Name:ROBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 W IRONWOOD DR
Mailing Address - Street 2:# 500
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4903
Mailing Address - Country:US
Mailing Address - Phone:208-667-1376
Mailing Address - Fax:208-292-0873
Practice Address - Street 1:850 W IRONWOOD DR
Practice Address - Street 2:# 500
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4903
Practice Address - Country:US
Practice Address - Phone:208-667-1376
Practice Address - Fax:208-292-0873
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID24686A363L00000X
WA60310022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner