Provider Demographics
NPI:1164073714
Name:ALLEN, AMANDA SUE
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SUE
Last Name:ALLEN
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 1:5530 S 47TH RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65770-7503
Mailing Address - Country:US
Mailing Address - Phone:417-741-2695
Mailing Address - Fax:
Practice Address - Street 1:5530 S 47TH RD
Practice Address - Street 2:
Practice Address - City:WALNUT GROVE
Practice Address - State:MO
Practice Address - Zip Code:65770-7503
Practice Address - Country:US
Practice Address - Phone:417-741-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider