Provider Demographics
NPI:1053111385
Name:PHINN, AMELIA RENE (RN, BN, CLEC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:RENE
Last Name:PHINN
Suffix:
Gender:
Credentials:RN, BN, CLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 SCOTTS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-2854
Mailing Address - Country:US
Mailing Address - Phone:775-527-4676
Mailing Address - Fax:
Practice Address - Street 1:7027 SCOTTS VALLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-2854
Practice Address - Country:US
Practice Address - Phone:775-527-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750263163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse