Basic Information
| Provider Information | |||||||||
| NPI: | 1396103222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATTERSALL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3805 COMPUTER DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197816200 | ||||||||
| FaxNumber: | 9197831819 | ||||||||
| Practice Location | |||||||||
| Address1: | 10941 RAVEN RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276146487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198477475 | ||||||||
| FaxNumber: | 9198477471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2016 | ||||||||
| LastUpdateDate: | 05/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 5008353 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.