Individual
MRS. AMANDA JO PRESTIGIACOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
350 N HAVEN DR, TWIN FALLS, ID 83301-5788
(208) 904-4780
(208) 904-4832
Mailing address
PO BOX 268934, OKLAHOMA CITY, OK 73126-8934
(208) 904-4780
(208) 904-4832
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
55632
ID
Other
Enumeration date
05/15/2017
Last updated
04/08/2021
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