MEDICARE: MRS. AMANDA LEE RUCIENSKI NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3013812	KY
2	363LF0000X	Family Nurse Practitioner	28255373A	IN
3	363LF0000X	Family Nurse Practitioner	SP013267	PA
4	363LF0000X	Family Nurse Practitioner	APRN.CNP.026313	OH
5	363LF0000X	Family Nurse Practitioner	123636	WV

General Provider Information

NPI Number	:	1760814081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LEE RUCIENSKI NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	378 W CHESTNUT ST STE 103
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-4661
Country	:	US
Telephone Number	:	412-660-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	4229 BARDSTOWN RD STE 218
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3266
Country	:	US
Telephone Number	:	502-749-7008
Fax Number	:	502-749-7012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	10/16/2025

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