Provider Demographics
NPI:1073849741
Name:PULTYNOVICH, AMANDA (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PULTYNOVICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1325
Mailing Address - Country:US
Mailing Address - Phone:717-248-5900
Mailing Address - Fax:
Practice Address - Street 1:110 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1325
Practice Address - Country:US
Practice Address - Phone:717-248-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026467363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology