Provider Demographics
NPI:1033575113
Name:HOLEN, AMANDA JANE (ARNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:HOLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JANE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 STATE AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030
Mailing Address - Country:US
Mailing Address - Phone:253-372-7866
Mailing Address - Fax:
Practice Address - Street 1:202 STATE AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031
Practice Address - Country:US
Practice Address - Phone:253-372-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60620377363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health