Healthcare Provider Details

I. General information

NPI: 1720954779
Provider Name (Legal Business Name): AMANDA L MAHANA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

1608 W HIGHLAND ST
SPRINGFIELD MO
65807-4401
US

V. Phone/Fax

Practice location:
  • Phone: 417-830-1048
  • Fax:
Mailing address:
  • Phone: 417-830-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2019021684
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: