Healthcare Provider Details

I. General information

NPI: 1932645553
Provider Name (Legal Business Name): AMANDA KENDLE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 01/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33811 9TH AVE S
FEDERAL WAY WA
98003-6707
US

IV. Provider business mailing address

33811 9TH AVE S
FEDERAL WAY WA
98003-6707
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-6525
  • Fax: 253-517-7706
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60492784
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: