| Doctor Name: | DR. AMANDA R SELF |
| NPI Number: | 1669548673 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 01062935A |
| Business Practice Address: | 7th Comm Bn Hq Co Bas Unit 35610 Fpo, AP - 966065610 |
| Business Phone Number: | 3184020604 |
| Business Fax Number: | |
| Mailing Address: | 3944 Highway 175, FRIERSON |
| State: | LA |
| Postal Code: | 710272159 |
| Phone Number: | 3184020604 |
| Fax Number: | |
| NPI Enumeration Date: | 11/28/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 01062935A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |