Healthcare Provider Details

I. General information

NPI: 1770351892
Provider Name (Legal Business Name): AMANDA PATERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 HOWARD AVE
ALTOONA PA
16601-4804
US

IV. Provider business mailing address

2764 WHITESEL RD
JAMES CREEK PA
16657-8640
US

V. Phone/Fax

Practice location:
  • Phone: 814-889-2011
  • Fax:
Mailing address:
  • Phone: 814-308-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number703000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: