Healthcare Provider Details

I. General information

NPI: 1659881217
Provider Name (Legal Business Name): AMANDA MARIE PICCIONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIE KILGUS

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 JPM RD STE 300
LEWISBURG PA
17837-9367
US

IV. Provider business mailing address

1 HOSPITAL DR STE 306
LEWISBURG PA
17837-9350
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-4446
  • Fax: 570-768-4623
Mailing address:
  • Phone: 570-522-4110
  • Fax: 570-768-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059399
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: