Provider Demographics
NPI:1104009612
Name:KREIENHEDER, AMANDA I
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KREIENHEDER
Suffix:I
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 1:4690 STAR MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8371
Mailing Address - Country:US
Mailing Address - Phone:406-253-3441
Mailing Address - Fax:
Practice Address - Street 1:3315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4966
Practice Address - Country:US
Practice Address - Phone:208-743-9543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-394364SR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation