Provider Demographics
NPI:1528663275
Name:BAINE, AMANDA LOUISE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUISE
Last Name:BAINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 COUNTY ROAD 539
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7107
Mailing Address - Country:US
Mailing Address - Phone:334-796-8622
Mailing Address - Fax:
Practice Address - Street 1:682 COUNTY ROAD 539
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-7107
Practice Address - Country:US
Practice Address - Phone:334-796-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF12200020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily