Provider Demographics
NPI:1033394549
Name:HEBERT, AMANDA J (CPO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:HEBERT
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 J N PEASE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4540
Mailing Address - Country:US
Mailing Address - Phone:704-721-6840
Mailing Address - Fax:
Practice Address - Street 1:1931 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4540
Practice Address - Country:US
Practice Address - Phone:704-510-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047KUOtherBCBS
NC7704797Medicaid
NC7704797Medicaid