Provider Demographics
NPI:1972086668
Name:RICHARD, AMANDA MINN (ARNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MINN
Last Name:RICHARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-2516
Mailing Address - Country:US
Mailing Address - Phone:712-852-5555
Mailing Address - Fax:712-852-5692
Practice Address - Street 1:3201 1ST ST
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-2516
Practice Address - Country:US
Practice Address - Phone:712-852-5555
Practice Address - Fax:712-852-5692
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA133680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily