Provider Demographics
NPI:1073946455
Name:ABASOLO, AMANDA BETH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BETH
Last Name:ABASOLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 E QUAIL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1136
Mailing Address - Country:US
Mailing Address - Phone:316-613-1057
Mailing Address - Fax:
Practice Address - Street 1:755 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4527
Practice Address - Country:US
Practice Address - Phone:316-866-2000
Practice Address - Fax:316-866-2084
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376110091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily