Healthcare Provider Details

I. General information

NPI: 1104739333
Provider Name (Legal Business Name): AMANDA CHANCE MSN, RN, NCSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 S EDGEMOOR ST STE 913
WICHITA KS
67218-3337
US

IV. Provider business mailing address

2725 E KEYS CT
DERBY KS
67037-7936
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-4475
  • Fax: 316-973-4571
Mailing address:
  • Phone: 316-640-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number13-101319
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: