Provider Demographics
NPI:1063707834
Name:MILHOLLAND, AMANDA LYNETTE (RT)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LYNETTE
Last Name:MILHOLLAND
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:318 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2113
Mailing Address - Country:US
Mailing Address - Phone:870-917-8650
Mailing Address - Fax:
Practice Address - Street 1:318 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2113
Practice Address - Country:US
Practice Address - Phone:870-917-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist