Healthcare Provider Details

I. General information

NPI: 1326936899
Provider Name (Legal Business Name): JANE MAUREEN AMATA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3215
APO AE
09094-3215
US

IV. Provider business mailing address

PSC 2 BOX 11668
APO AE
09012-0117
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2032
  • Fax:
Mailing address:
  • Phone: 314-479-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR214034
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR214034
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR214034
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: