MEDICARE: MRS. AMANDA LYNNE MCGLADE NP-C

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	F1008194	PA

General Provider Information

NPI Number	:	1932354131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LYNNE MCGLADE NP-C

Provider Business Mailing Address
First Line	:	727 WELSH RD
Second Line	:	SUITE 101
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6310
Country	:	US
Telephone Number	:	215-914-0600
Fax Number	:	215-914-0115

Provider Business Practice Location Address
First Line	:	727 WELSH RD
Second Line	:	SUITE 101
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6310
Country	:	US
Telephone Number	:	215-914-0600
Fax Number	:	215-914-0115

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

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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