MEDICARE: AMANDA L HYSLOP APN

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	363L00000X	Nurse Practitioner	AP60464449	WA

General Provider Information

NPI Number	:	1770888323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA L HYSLOP APN

Provider Business Mailing Address
First Line	:	955 POWELL AVE SW
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057
Country	:	US
Telephone Number	:	425-277-1311
Fax Number	:

Provider Business Practice Location Address
First Line	:	3244 W AINSLIE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5018
Country	:	US
Telephone Number	:	773-776-6100
Fax Number	:

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

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	09/29/2015

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