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NPI Code Detail

MEDICARE: AMANDA RAY APN

MEDICARE: AMANDA RAY 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
1363LF0000XFamily Nurse Practitioner209008019IL

General Provider Information

NPI Number : 1972817468
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA RAY APN
Provider Business Mailing Address
First Line : 161 WASHINGTON STREET, 14TH FLOOR
Second Line : EIGHT TOWER BRIDGE, SUITE 1400
City : CONSHOHOCKEN
State : PA
Zip : 19428
Country : US
Telephone Number : 866-825-3227
Fax Number :
Provider Business Practice Location Address
First Line : 5625 N RIDGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-3434
Country : US
Telephone Number : 866-825-3227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2010
Last Update Date : 07/27/2010

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