1164985362 NPI number — AMANDA LAUREN HORTON APRN

Table of content: AMANDA LAUREN HORTON APRN (NPI 1164985362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164985362 NPI number — AMANDA LAUREN HORTON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORTON
Provider First Name:
AMANDA
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAWLEY
Provider Other First Name:
AMANDA
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164985362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3325 RESEARCH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89706-7913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-888-6610
Provider Business Mailing Address Fax Number:
775-888-4904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3325 RESEARCH WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89706-7913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-887-5140
Provider Business Practice Location Address Fax Number:
775-884-3618
Provider Enumeration Date:
04/13/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  820072 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 820072 . This is a "APRN LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".