Healthcare Provider Details

I. General information

NPI: 1346871506
Provider Name (Legal Business Name): AMANDA ABIGAIL GAZIANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LYNN

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 HARRISBURG PIKE
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2102 HARRISBURG PIKE
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3968
  • Fax: 717-544-9401
Mailing address:
  • Phone: 717-544-3968
  • Fax: 717-544-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP022257
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number153511
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN725614
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: