Provider Demographics
NPI:1679316640
Name:DEAVERS, AMANDA LYNN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:DEAVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:TUNNELTON
Mailing Address - State:WV
Mailing Address - Zip Code:26444-7213
Mailing Address - Country:US
Mailing Address - Phone:681-270-0713
Mailing Address - Fax:
Practice Address - Street 1:89 HICKORY LN
Practice Address - Street 2:
Practice Address - City:TUNNELTON
Practice Address - State:WV
Practice Address - Zip Code:26444-7213
Practice Address - Country:US
Practice Address - Phone:681-270-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant