Healthcare Provider Details

I. General information

NPI: 1861158529
Provider Name (Legal Business Name): AMANDA LIESNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 EASTON ROAD SUITE 2700
WARRINGTON PA
18976-2909
US

IV. Provider business mailing address

847 EASTON ROAD
WARRINGTON PA
18976-2909
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-0105
  • Fax: 215-345-0562
Mailing address:
  • Phone: 215-345-0105
  • Fax: 215-345-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP024722
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: