Healthcare Provider Details

I. General information

NPI: 1053588848
Provider Name (Legal Business Name): AMANDA S PATTANAYAK ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CHOCTAW ST
ASHEVILLE NC
28801-4513
US

IV. Provider business mailing address

PO BOX 603443
CHARLOTTE NC
28260-3443
US

V. Phone/Fax

Practice location:
  • Phone: 828-255-7733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004573
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number237113
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number230797
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237113
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number230797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: