Provider Demographics
NPI:1003223371
Name:MARR, AMANDA KATHRYN (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KATHRYN
Last Name:MARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35141 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19967-6954
Mailing Address - Country:US
Mailing Address - Phone:302-537-3740
Mailing Address - Fax:
Practice Address - Street 1:35141 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6954
Practice Address - Country:US
Practice Address - Phone:302-537-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000111363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health