Provider Demographics
NPI:1760873491
Name:NEFSTEAD, AMANDA KRISTINE (ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KRISTINE
Last Name:NEFSTEAD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 17TH AVE E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-5273
Mailing Address - Country:US
Mailing Address - Phone:132-076-2114
Mailing Address - Fax:320-762-1935
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:SUITE 101
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5273
Practice Address - Country:US
Practice Address - Phone:132-076-2114
Practice Address - Fax:320-762-1935
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND664-142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer