Individual
AMANDA VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 W MAIN ST APT 115, EDMOND, OK 73003-5319
(316) 208-1340
Mailing address
100 W MAIN ST APT 115, EDMOND, OK 73003-5319
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
07/28/2026
Last updated
07/28/2026
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