Provider Demographics
NPI:1255696001
Name:BADER, AMANDA ELAINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:BADER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SEMO DR
Mailing Address - Street 2:P.O. BOX 400
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-1734
Mailing Address - Country:US
Mailing Address - Phone:573-748-2404
Mailing Address - Fax:573-748-8929
Practice Address - Street 1:741 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BERNIE
Practice Address - State:MO
Practice Address - Zip Code:63822-8900
Practice Address - Country:US
Practice Address - Phone:573-293-6836
Practice Address - Fax:573-293-6838
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012022612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily