Healthcare Provider Details

I. General information

NPI: 1831700533
Provider Name (Legal Business Name): AMANDA L KOCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S GOVERNORS AVE STE 100
DOVER DE
19904-3530
US

IV. Provider business mailing address

640 S STATE STREET, MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-526-1470
  • Fax: 302-674-1398
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0011462
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0011462
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: