Healthcare Provider Details

I. General information

NPI: 1588031355
Provider Name (Legal Business Name): AMANDA HANNAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA EALING

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-1994
  • Fax: 740-374-7701
Mailing address:
  • Phone: 740-374-7700
  • Fax: 740-374-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005022RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10001898A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: