MEDICARE: AMANDA J PRINCE CHEN CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	693186	TX

General Provider Information

NPI Number	:	1316170160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA J PRINCE CHEN CPNP

Provider Business Mailing Address
First Line	:	1009 N 4TH ST
Second Line	:	SUITE B
City	:	LONGVIEW
State	:	TX
Zip	:	75601-4768
Country	:	US
Telephone Number	:	903-212-4330
Fax Number	:	903-212-4333

Provider Business Practice Location Address
First Line	:	1009 N 4TH ST
Second Line	:	SUITE B
City	:	LONGVIEW
State	:	TX
Zip	:	75601-4768
Country	:	US
Telephone Number	:	903-212-4330
Fax Number	:	903-212-4333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	08/07/2013

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