Provider Demographics
NPI:1679340954
Name:MUNCY, AMANDA LEE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:MUNCY
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:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:SUMERCO
Mailing Address - State:WV
Mailing Address - Zip Code:25567-0063
Mailing Address - Country:US
Mailing Address - Phone:304-524-7610
Mailing Address - Fax:
Practice Address - Street 1:82 JOES CREEK
Practice Address - Street 2:
Practice Address - City:SOD
Practice Address - State:WV
Practice Address - Zip Code:25564
Practice Address - Country:US
Practice Address - Phone:304-524-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant