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NPI Code Detail

MEDICARE: AMANDA SULLIVAN BAHLER APRN

MEDICARE: AMANDA SULLIVAN BAHLER APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner6612CT
2363LA2100XAcute Care Nurse Practitioner6612CT

General Provider Information

NPI Number : 1245785013
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA SULLIVAN BAHLER APRN
Provider Business Mailing Address
First Line : 80 SEYMOUR STREET
Second Line :
City : HARTFORD
State : CT
Zip : 06102-5037
Country : US
Telephone Number : 860-545-5000
Fax Number :
Provider Business Practice Location Address
First Line : 105 CARNEGIE PL STE 103
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-5900
Country : US
Telephone Number : 770-716-7999
Fax Number : 770-716-8444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2016
Last Update Date : 05/09/2024

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Directions to “ AMANDA SULLIVAN BAHLER APRN” Practice Location

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