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General NPI Number Information
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NPI Number | 1093101768
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Entity Type | Individual
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Provider Name | AMANDA LYNNE MUNDEN APRN
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Gender | Female
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 8200 W 71ST ST
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City | SHAWNEE MISSION
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State | KS
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Zip | 66204-1715
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Country | US
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Telephone | 913-549-9970
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Fax |
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Provider Business Mailing Address
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Address Line | 14617 S BROUGHAM DR
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City | OLATHE
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State | KS
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Zip | 66062-2530
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Country | US
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Telephone | 913-209-2725
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015005058
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 76701
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License Number State | KS
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