Provider Demographics
NPI:1174892194
Name:BARGER, AMANDA ROSALIE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSALIE
Last Name:BARGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ROSALIE
Other - Last Name:BASHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8766 E. HWY 69
Mailing Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT #22/SSO
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-759-4042
Mailing Address - Fax:928-759-4030
Practice Address - Street 1:8766 E. HWY 69
Practice Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT #22/SSO
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4042
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN169163163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool