Provider Demographics
NPI:1184479933
Name:BIALAS, AMANDA LOUISE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUISE
Last Name:BIALAS
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 1:1406 ESTES LN
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2936
Mailing Address - Country:US
Mailing Address - Phone:307-680-6154
Mailing Address - Fax:
Practice Address - Street 1:1406 ESTES LN
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2936
Practice Address - Country:US
Practice Address - Phone:307-680-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator