Provider Demographics
NPI:1306626619
Name:MISSET, AMANDA WERNER (DNP)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:WERNER
Last Name:MISSET
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BETH
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1008 20TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4511
Mailing Address - Country:US
Mailing Address - Phone:443-340-6924
Mailing Address - Fax:
Practice Address - Street 1:17075 DEVONSHIRE ST STE 205
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5408
Practice Address - Country:US
Practice Address - Phone:818-366-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily