Provider Demographics
NPI:1114112018
Name:OLIVER, AMANDA R (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:232 WEST 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544
Mailing Address - Country:US
Mailing Address - Phone:814-452-5337
Mailing Address - Fax:814-452-5442
Practice Address - Street 1:2315 MYRTLE ST
Practice Address - Street 2:SUITE 290
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4602
Practice Address - Country:US
Practice Address - Phone:814-454-1142
Practice Address - Fax:814-454-1255
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant