Healthcare Provider Details

I. General information

NPI: 1104232347
Provider Name (Legal Business Name): LAURA AMANN STORM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA CATHERINE AMANN PA-C

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 3 SILVERSTEIN BLDG
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST 3 SILVERSTEIN BLDG
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3487
  • Fax:
Mailing address:
  • Phone: 215-662-3487
  • Fax: 215-349-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056952
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: