Provider Demographics
NPI:1114003027
Name:AMENDT, ALISHA (CRNP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:AMENDT
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 1:100 E LANCASTER AVE STE 256
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3432
Mailing Address - Country:US
Mailing Address - Phone:484-572-6300
Mailing Address - Fax:484-572-6305
Practice Address - Street 1:100 E LANCASTER AVE STE 256
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3432
Practice Address - Country:US
Practice Address - Phone:484-572-6300
Practice Address - Fax:484-572-6305
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009200363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106172EQSMedicare PIN
PAQ76274Medicare UPIN