Provider Demographics
NPI:1275421075
Name:VANCLEAVE, AMANDA MARIE (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2110 S 78TH ST E
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-8229
Mailing Address - Country:US
Mailing Address - Phone:918-936-1757
Mailing Address - Fax:
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-577-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0118127163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse