Healthcare Provider Details

I. General information

NPI: 1710746029
Provider Name (Legal Business Name): AMANDA LYNN ESMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 GROVE ST STE G1
MEADVILLE PA
16335-2945
US

IV. Provider business mailing address

751 LIBERTY ST
MEADVILLE PA
16335-2591
US

V. Phone/Fax

Practice location:
  • Phone: 814-807-1202
  • Fax: 814-807-1210
Mailing address:
  • Phone: 814-333-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP029476
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: