Provider Demographics
NPI:1306454368
Name:PRYMAK, AMANDA (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PRYMAK
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 1:435 MAUREEN CIR
Mailing Address - Street 2:
Mailing Address - City:MAPLEVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02839-1141
Mailing Address - Country:US
Mailing Address - Phone:603-723-6622
Mailing Address - Fax:
Practice Address - Street 1:120 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-1168
Practice Address - Country:US
Practice Address - Phone:603-723-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN64460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse