Provider Demographics
NPI:1467332155
Name:WOOD, AMANDA FAIR (LPN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAIR
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 N SIESTA SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-7814
Mailing Address - Country:US
Mailing Address - Phone:928-759-4610
Mailing Address - Fax:928-759-4696
Practice Address - Street 1:6411 N ROBERT RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-9146
Practice Address - Country:US
Practice Address - Phone:928-759-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ296359164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse