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NPI Code Detail

MEDICARE: AMANDA K WESTMORELAND PA

MEDICARE: AMANDA K WESTMORELAND PA
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
1363A00000XPhysician Assistant1979WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11979OTHERWILICENSE

General Provider Information

NPI Number : 1285671032
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA K WESTMORELAND PA
Provider Business Mailing Address
First Line : 820 ARBUTUS AVE
Second Line :
City : OCONTO
State : WI
Zip : 54153-2004
Country : US
Telephone Number : 920-835-1100
Fax Number : 920-835-1099
Provider Business Practice Location Address
First Line : 820 ARBUTUS AVE
Second Line :
City : OCONTO
State : WI
Zip : 54153-2004
Country : US
Telephone Number : 920-835-1100
Fax Number : 920-835-1099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 08/02/2012

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Directions to “ AMANDA K WESTMORELAND PA” Practice Location

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