Provider Demographics
NPI:1932506276
Name:MCGEE, AMANDA SUE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:MCGEE
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 1:225 DAKOTA CT
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1600
Mailing Address - Country:US
Mailing Address - Phone:501-247-6258
Mailing Address - Fax:
Practice Address - Street 1:225 DAKOTA CT
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1600
Practice Address - Country:US
Practice Address - Phone:501-247-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1822858146N00000X
1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians