Healthcare Provider Details

I. General information

NPI: 1821865403
Provider Name (Legal Business Name): AMANDA LIBRIZZI MUTH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 EPSON PLANTATION DR
MONCKS CORNER SC
29461-3979
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number27671
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: