Provider Demographics
NPI:1306436522
Name:WARD, AMANDA RAE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:WARD
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:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:MAC ARTHUR
Mailing Address - State:WV
Mailing Address - Zip Code:25873-0052
Mailing Address - Country:US
Mailing Address - Phone:304-228-3233
Mailing Address - Fax:
Practice Address - Street 1:107 PLUTO DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-228-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant