Provider Demographics
NPI:1093377038
Name:ROWLES, AMANDA CLAIRE (RN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:CLAIRE
Last Name:ROWLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-1441
Mailing Address - Country:US
Mailing Address - Phone:651-278-2308
Mailing Address - Fax:
Practice Address - Street 1:720 RIVER RD
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-1441
Practice Address - Country:US
Practice Address - Phone:651-278-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2475298163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2475298OtherREGISTERED NURSE