Provider Demographics
NPI:1700522422
Name:AMANDA STEEN FNP INC
Entity Type:Organization
Organization Name:AMANDA STEEN FNP INC
Other - Org Name:TAYLOR MADE HEALTH AND WELLNESS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:STEEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:870-448-4489
Mailing Address - Street 1:403 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-7702
Mailing Address - Country:US
Mailing Address - Phone:870-448-4489
Mailing Address - Fax:870-448-4894
Practice Address - Street 1:403 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-7702
Practice Address - Country:US
Practice Address - Phone:870-504-2944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMANDA STEEN FNP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-05
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1629532155OtherNPI