Individual
AMANDA JO REZBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1115 BOULDERS PKWY, SUITE 100, NORTH CHESTERFIELD, VA 23225-4067
(804) 320-1339
(804) 330-5829
Mailing address
1115 BOULDERS PKWY, SUITE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0001199728
VA
363LF0000X
Family Nurse Practitioner
0024167583
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245411537
—
VA
01
—
P00703382
MEDICARE RR
—
Enumeration date
11/15/2007
Last updated
05/23/2014
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