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General NPI Number Information
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NPI Number | 1407189210
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Entity Type | Individual
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Provider Name | AMANDA RENEE KOCH PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 1416 PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2134
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Country | US
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Telephone | 610-376-3936
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Fax | 610-372-0215
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Provider Business Mailing Address
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Address Line | 1416 PENN AVE
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City | WYOMISSING
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State | PA
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Zip | 19610-2134
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Country | US
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Telephone | 610-376-3936
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Fax | 610-372-0215
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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