Provider Demographics
NPI:1497801377
Name:HENZEL, AMANDA ANNE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANNE
Last Name:HENZEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 29TH ST S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5316
Mailing Address - Country:US
Mailing Address - Phone:406-761-7924
Mailing Address - Fax:
Practice Address - Street 1:1400 29TH ST S
Practice Address - Street 2:SUITE 101
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5316
Practice Address - Country:US
Practice Address - Phone:406-761-7924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11389207V00000X
OK23590207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology