Healthcare Provider Details

I. General information

NPI: 1366236499
Provider Name (Legal Business Name): JEFFREY PAUL AMUNDSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CEDAR CREST BLVD STE 205
ALLENTOWN PA
18103-6271
US

IV. Provider business mailing address

2100 MACK BLVD FL 4
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-9116
  • Fax:
Mailing address:
  • Phone: 484-884-5400
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP033977
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN690860
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: