Provider Demographics
NPI:1972891273
Name:CHRISTIAN, AMANDA MARIE (APRN, CNM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 SIERRA ROSE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4026
Mailing Address - Country:US
Mailing Address - Phone:775-828-1200
Mailing Address - Fax:
Practice Address - Street 1:645 SIERRA ROSE DR STE 205
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4026
Practice Address - Country:US
Practice Address - Phone:775-828-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001324367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1972891273Medicaid
12401844OtherCAQH