Healthcare Provider Details

I. General information

NPI: 1306733035
Provider Name (Legal Business Name): AMANDA NICHOLE MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 COLONNADE BLVD
STATE COLLEGE PA
16803-2668
US

IV. Provider business mailing address

239 COLONNADE BLVD
STATE COLLEGE PA
16803-2668
US

V. Phone/Fax

Practice location:
  • Phone: 582-220-2205
  • Fax: 582-220-2205
Mailing address:
  • Phone: 582-220-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN711545
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: