Individual
AMANDA IGATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
101 AUBREYS LOOP, SOUTH BOSTON, VA 24592-5056
(434) 517-3879
Mailing address
101 AUBREYS LOOP, SOUTH BOSTON, VA 24592-5056
(434) 517-3879
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171074
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024171074
VA LICENSE
VA
Enumeration date
08/02/2013
Last updated
05/21/2024
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