Healthcare Provider Details

I. General information

NPI: 1003282609
Provider Name (Legal Business Name): AMANDA FREMER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MILLER PA-C

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MAIN ST.
DUBOIS PA
15801-0000
US

IV. Provider business mailing address

621 MAIN ST.
DUBOIS PA
15801-0000
US

V. Phone/Fax

Practice location:
  • Phone: 814-299-7520
  • Fax: 814-299-7591
Mailing address:
  • Phone: 814-299-7520
  • Fax: 814-299-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057697
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003580
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: