MEDICARE: AMY LANDIS CRNP

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
1	363LP0200X	Pediatric Nurse Practitioner	VP006401D	PA

General Provider Information

NPI Number	:	1568431757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LANDIS CRNP

Provider Business Mailing Address
First Line	:	11279 PERRY HWY STE 450
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-9303
Country	:	US
Telephone Number	:	724-933-1100
Fax Number	:	724-933-1160

Provider Business Practice Location Address
First Line	:	1600 CORAOPOLIS HEIGHTS RD STE E
Second Line	:
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-4316
Country	:	US
Telephone Number	:	412-262-2415
Fax Number	:	412-262-1537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	12/13/2017

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