Healthcare Provider Details

I. General information

NPI: 1780415117
Provider Name (Legal Business Name): AMANDA TOKARICK-MOYER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DAVES WAY
HAMBURG PA
19526-1413
US

IV. Provider business mailing address

9 DAVES WAY
HAMBURG PA
19526-1413
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-7201
  • Fax: 610-628-7211
Mailing address:
  • Phone: 610-628-7201
  • Fax: 610-628-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP030288
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: