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General NPI Number Information
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NPI Number | 1831594274
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Entity Type | Individual
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Provider Name | AMANDA JOAN AMICUCCI CPC
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Gender | Female
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 221 WELLS AVE S SUITE 100
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City | RENTON
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State | WA
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Zip | 98057-2161
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Country | US
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Telephone | 425-528-2008
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 165TH AVENUE CT E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-4928
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Country | US
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Telephone | 206-643-0283
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | WA
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