Basic Information
| Provider Information | |||||||||
| NPI: | 1083212195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORGERSON | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8343 HAWK EYE RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871203788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038198954 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 202 PROSPECT DR | ||||||||
| Address2: | |||||||||
| City: | GLENDIVE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593301999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063453306 | ||||||||
| FaxNumber: | 4063453312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2020 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 60966 | NM | N | Nursing Service Providers | Registered Nurse | 363L00000X | 176580 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | CNP-60966 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.