Provider Demographics
NPI:1003087750
Name:SITES, AMANDA DAWN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:SITES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 FLOWING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-4712
Mailing Address - Country:US
Mailing Address - Phone:304-725-8491
Mailing Address - Fax:
Practice Address - Street 1:4141 FLOWING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH JUNCTION
Practice Address - State:WV
Practice Address - Zip Code:25442-4712
Practice Address - Country:US
Practice Address - Phone:304-725-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3178163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9705102000Medicaid