Provider Demographics
NPI:1346638137
Name:GISLER, AMANDA RAE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:GISLER
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 1:86 RIO VISTA LN
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2081
Mailing Address - Country:US
Mailing Address - Phone:530-840-7007
Mailing Address - Fax:
Practice Address - Street 1:818 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2759
Practice Address - Country:US
Practice Address - Phone:530-527-8491
Practice Address - Fax:530-527-0240
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator