Provider Demographics
NPI:1780353284
Name:MEEHAN, AMANDA (FNTP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 NW 196TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3639
Mailing Address - Country:US
Mailing Address - Phone:405-517-4843
Mailing Address - Fax:
Practice Address - Street 1:2336 NW 196TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-3639
Practice Address - Country:US
Practice Address - Phone:405-517-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date: