Provider Demographics
NPI:1285398396
Name:QUINN, AMANDA LEANN (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEANN
Last Name:QUINN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 STONEY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-9071
Mailing Address - Country:US
Mailing Address - Phone:501-732-0247
Mailing Address - Fax:
Practice Address - Street 1:193 STONEY RIDGE LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-9071
Practice Address - Country:US
Practice Address - Phone:501-732-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR100508163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARRN100508OtherRN