Provider Demographics
NPI:1124834924
Name:AMOAH, AMANDA APEGYINE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:APEGYINE
Last Name:AMOAH
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 1:405 N 5TH ST APT APT 113
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4412
Mailing Address - Country:US
Mailing Address - Phone:507-340-7962
Mailing Address - Fax:
Practice Address - Street 1:405 N 5TH ST APT APT 113
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4412
Practice Address - Country:US
Practice Address - Phone:507-340-7962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN417938374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide