Healthcare Provider Details

I. General information

NPI: 1093377038
Provider Name (Legal Business Name): AMANDA CLAIRE ROWLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 STATE ROAD 35
CENTURIA WI
54824-8024
US

IV. Provider business mailing address

510 STATE ROAD 35
CENTURIA WI
54824-8024
US

V. Phone/Fax

Practice location:
  • Phone: 651-278-2308
  • Fax:
Mailing address:
  • Phone: 651-278-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2475298
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: