Provider Demographics
NPI:1851119119
Name:HAYES, AMANDA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HAYES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12404 SMOKEY MOUNTAIN WAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7274
Mailing Address - Country:US
Mailing Address - Phone:505-595-4515
Mailing Address - Fax:
Practice Address - Street 1:520 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5535
Practice Address - Country:US
Practice Address - Phone:541-472-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10032636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily