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General NPI Number Information
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NPI Number | 1043029036
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Entity Type | Individual
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Provider Name | AMANDA MARIE EICHHOLZ PA
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Gender | Female
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 2710 S RIFE MEDICAL LN
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City | ROGERS
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State | AR
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Zip | 72758-1452
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Country | US
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Telephone | 479-381-2694
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 SW TUNICA CT
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City | BENTONVILLE
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State | AR
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Zip | 72712-3661
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Country | US
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Telephone | 479-381-2694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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