Healthcare Provider Details

I. General information

NPI: 1023546843
Provider Name (Legal Business Name): AMANDA L CREEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA HANCE NP

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMERCE LN
CANTON NY
13617-3739
US

IV. Provider business mailing address

4 COMMERCE LN
CANTON NY
13617-3739
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-8191
  • Fax: 315-386-1410
Mailing address:
  • Phone: 315-386-8191
  • Fax: 315-386-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number551870
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: