MEDICARE: AMANDA MARIE CONROY 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	207N00000X	Dermatology Physician	SP017736	PA
2	363LF0000X	Family Nurse Practitioner	SP017736	PA

General Provider Information

NPI Number	:	1740791763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE CONROY CRNP

Provider Business Mailing Address
First Line	:	1650 CROOKED OAK DR STE 200
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-4278
Country	:	US
Telephone Number	:	717-569-3279
Fax Number	:	717-569-2187

Provider Business Practice Location Address
First Line	:	1650 CROOKED OAK DR STE 200
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-4278
Country	:	US
Telephone Number	:	717-569-3279
Fax Number	:	717-569-2187

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

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	09/15/2022

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