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General NPI Number Information
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NPI Number | 1073055414
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Entity Type | Organization
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Legal Business Name | AMANDA ANDERSON, MMS, PA-C, PLLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE STE 309
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City | GLENDALE
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State | AZ
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Zip | 85308-8730
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Country | US
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Telephone | 623-321-2221
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Fax | 855-397-2676
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Provider Business Mailing Address
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Address Line | 17505 N 79TH AVE STE 309
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City | GLENDALE
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State | AZ
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Zip | 85308-8730
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Country | US
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Telephone | 623-321-2221
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Fax | 855-397-2676
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MANDIE MILLER
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Credential | DMS, PA-C
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Telephone | 623-321-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4918
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License Number State | AZ
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