Provider Demographics
NPI:1316170160
Name:PRINCE CHEN, AMANDA J (CPNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:PRINCE CHEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1009 N 4TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4768
Mailing Address - Country:US
Mailing Address - Phone:903-212-4330
Mailing Address - Fax:903-212-4333
Practice Address - Street 1:1009 N 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4768
Practice Address - Country:US
Practice Address - Phone:903-212-4330
Practice Address - Fax:903-212-4333
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX693186363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics