Provider Demographics
NPI:1689909103
Name:SAUNDERS, AMANDA STAR (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:STAR
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 SHED RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3154
Mailing Address - Country:US
Mailing Address - Phone:318-747-0540
Mailing Address - Fax:318-741-5700
Practice Address - Street 1:2910 SHED RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3154
Practice Address - Country:US
Practice Address - Phone:318-747-0540
Practice Address - Fax:318-741-5700
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05837363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2117254Medicaid