Provider Demographics
NPI:1104960673
Name:RENO, AMANDA MARIE
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:RENO
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 1:9400 TOMASHAW LN
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1956
Mailing Address - Country:US
Mailing Address - Phone:913-492-1954
Mailing Address - Fax:
Practice Address - Street 1:9400 TOMASHAW LN
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1956
Practice Address - Country:US
Practice Address - Phone:913-492-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide