Provider Demographics
NPI:1588936249
Name:STEIDL, AMANDA MARY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARY
Last Name:STEIDL
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 1:725 ELM ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1760
Mailing Address - Country:US
Mailing Address - Phone:320-763-6018
Mailing Address - Fax:320-763-4127
Practice Address - Street 1:725 ELM ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1760
Practice Address - Country:US
Practice Address - Phone:320-763-6018
Practice Address - Fax:320-763-4127
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL615039164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse