Provider Demographics
NPI:1003368770
Name:PACZKOWSKI, AMANDA LEAH (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEAH
Last Name:PACZKOWSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 HIGBEE DR
Mailing Address - Street 2:SUITE D 202
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-4200
Mailing Address - Country:US
Mailing Address - Phone:412-833-6176
Mailing Address - Fax:412-833-6421
Practice Address - Street 1:1000 HIGBEE DR
Practice Address - Street 2:SUITE D 202
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-4200
Practice Address - Country:US
Practice Address - Phone:412-833-6176
Practice Address - Fax:412-833-6421
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP016405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034419410001Medicaid