Provider Demographics
NPI:1477263366
Name:STANSBURY, AMANDA LEE (LPN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E DAWN ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4309
Mailing Address - Country:US
Mailing Address - Phone:122-577-3969
Mailing Address - Fax:
Practice Address - Street 1:1205 E DAWN ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4309
Practice Address - Country:US
Practice Address - Phone:225-773-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA990086164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse