Provider Demographics
NPI:1164844221
Name:GUENZEL, AMANDA LYNNE
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNNE
Last Name:GUENZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LYNNE
Other - Last Name:FRONTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 819 BOX 9
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0001
Mailing Address - Country:US
Mailing Address - Phone:616-805-1248
Mailing Address - Fax:
Practice Address - Street 1:3375 S HOOVER ST
Practice Address - Street 2:STE H201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0116
Practice Address - Country:US
Practice Address - Phone:866-740-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program