Basic Information
| Provider Information | |||||||||
| NPI: | 1053303511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYLUND | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | PARKER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 HIGHWAY 6 | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774784941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814944832 | ||||||||
| FaxNumber: | 2814947399 | ||||||||
| Practice Location | |||||||||
| Address1: | 17500 W GRAND PKWY S | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774792562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817255150 | ||||||||
| FaxNumber: | 2817255611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 11/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | M0519 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 173740505 | 05 | TX | MEDICAID | 173740501 | 05 | TX | MEDICAID | 173740504 | 05 | TX | MEDICAID | 8R8311 | 01 | TX | BCBS | OTHER |