MEDICARE: AMANDA MARIE TEBLUNTHUIS

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	207Q00000X	Family Medicine Physician	ML.61063160	WA
2	207Q00000X	Family Medicine Physician	V2292	TX

General Provider Information

NPI Number	:	1962030486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE TEBLUNTHUIS

Provider Business Mailing Address
First Line	:	1900 ALDRICH ST STE 150
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3597
Country	:	US
Telephone Number	:	888-663-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 ALDRICH ST STE 150
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-3597
Country	:	US
Telephone Number	:	888-663-6331
Fax Number	:	415-252-7176

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	03/14/2025

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Directions to “ AMANDA MARIE TEBLUNTHUIS ” Practice Location

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