Provider Demographics
NPI:1053195818
Name:CRANDELL, AMANDA LYNNE (ARNP, NNP BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:ARNP, NNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 116TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-3030
Mailing Address - Country:US
Mailing Address - Phone:253-426-2932
Mailing Address - Fax:
Practice Address - Street 1:316 S I ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4212
Practice Address - Country:US
Practice Address - Phone:253-403-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61501078363LN0000X
WARN60370970163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal