Healthcare Provider Details

I. General information

NPI: 1700105715
Provider Name (Legal Business Name): AMANDA L NEFF LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 OKLAHOMA AVE
TRENTON MO
64683-2565
US

IV. Provider business mailing address

900 E LAHARPE ST
KIRKSVILLE MO
63501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-4600
  • Fax: 660-359-4286
Mailing address:
  • Phone: 660-665-1962
  • Fax: 660-665-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2009027364
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: