Provider Demographics
NPI:1972078384
Name:DIGITALE, AMANDA (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DIGITALE
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 1:540 REVERE BEACH BLVD UNIT 519
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4759
Mailing Address - Country:US
Mailing Address - Phone:617-780-2268
Mailing Address - Fax:
Practice Address - Street 1:540 REVERE BEACH BLVD UNIT 519
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4759
Practice Address - Country:US
Practice Address - Phone:617-780-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2297938163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health