Healthcare Provider Details

I. General information

NPI: 1932433612
Provider Name (Legal Business Name): AMANDA HARMON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COLLEGE AVE
BEAVER PA
15009-2706
US

IV. Provider business mailing address

250 COLLEGE AVE
BEAVER PA
15009-2706
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-4070
  • Fax: 724-774-2872
Mailing address:
  • Phone: 724-774-4070
  • Fax: 724-774-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: