Provider Demographics
NPI:1154554715
Name:HOLDER, AMANDA KAYE (RN)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KAYE
Last Name:HOLDER
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Gender:F
Credentials:RN
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Mailing Address - Street 1:7856 WESTSIDE PARK DR
Mailing Address - Street 2:STE C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8541
Mailing Address - Country:US
Mailing Address - Phone:251-633-8090
Mailing Address - Fax:251-633-8864
Practice Address - Street 1:7856 WESTSIDE PARK DR
Practice Address - Street 2:STE C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-8541
Practice Address - Country:US
Practice Address - Phone:251-633-8090
Practice Address - Fax:251-633-8864
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
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Provider Licenses
StateLicense IDTaxonomies
MO152140163W00000X, 163WI0500X
MSR881325163W00000X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy