MEDICARE: AMANDA NORRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1629852165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NORRIS

Provider Business Mailing Address
First Line	:	7514 HENDERSON GIN RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-3434
Country	:	US
Telephone Number	:	318-936-0656
Fax Number	:

Provider Business Practice Location Address
First Line	:	7514 HENDERSON GIN RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-3434
Country	:	US
Telephone Number	:	318-936-0656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	08/24/2023

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Directions to “ AMANDA NORRIS ” Practice Location

Language	Start Address	Practice Location

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