Provider Demographics
NPI:1770029704
Name:HONOR, AMANDA RACHEL
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHEL
Last Name:HONOR
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 1:8930 OCEAN DR
Mailing Address - Street 2:HANGAR 41
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78419-5201
Mailing Address - Country:US
Mailing Address - Phone:361-939-6270
Mailing Address - Fax:
Practice Address - Street 1:8930 OCEAN DR
Practice Address - Street 2:HANGAR 41
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419-5201
Practice Address - Country:US
Practice Address - Phone:361-939-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-14
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332000000X247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316044167OtherUSCG HOUSTON-GALVESTON