Provider Demographics
NPI:1902485477
Name:MABE, AMANDA LEIGH (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEIGH
Last Name:MABE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SUNSET BLVD N STE C
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28468-4340
Mailing Address - Country:US
Mailing Address - Phone:910-795-1700
Mailing Address - Fax:910-661-0683
Practice Address - Street 1:710 SUNSET BLVD N STE C
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-4340
Practice Address - Country:US
Practice Address - Phone:336-613-4862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231639163W00000X
NC5014325363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty