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General NPI Number Information
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NPI Number | 1104216001
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Entity Type | Individual
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Provider Name | AMANDA NEZAT
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Gender | Female
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 100 TOBY TRL
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City | HUTTO
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State | TX
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Zip | 78634-5249
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Country | US
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Telephone | 512-642-4076
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Fax |
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Provider Business Mailing Address
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Address Line | 12201A TYSON CV DUPLEX A
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City | AUSTIN
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State | TX
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Zip | 78758-5310
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Country | US
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Telephone | 512-644-6926
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 58240102769
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 58240102769
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License Number State | TX
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