Provider Demographics
NPI:1699056069
Name:ANDERSON, AMANDA L (CNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 N SIOUX POINT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5091
Mailing Address - Country:US
Mailing Address - Phone:605-217-5500
Mailing Address - Fax:605-217-5515
Practice Address - Street 1:345 W STEAMBOAT DR STE 601
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5287
Practice Address - Country:US
Practice Address - Phone:605-217-5617
Practice Address - Fax:605-217-5533
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SDCP000647363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily