Healthcare Provider Details

I. General information

NPI: 1710768106
Provider Name (Legal Business Name): AMANDA MAZONKEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 OLD WILLIAM PENN HWY SUITE 3
EXPORT PA
15632
US

IV. Provider business mailing address

105 CLEARVIEW DR
APOLLO PA
15613
US

V. Phone/Fax

Practice location:
  • Phone: 412-952-7592
  • Fax:
Mailing address:
  • Phone: 724-799-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP026305
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: