Provider Demographics
NPI:1114580495
Name:MCDONAGH, AMANDA C (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:C
Last Name:MCDONAGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15496 ABBEY CIR
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-9678
Mailing Address - Country:US
Mailing Address - Phone:563-590-3616
Mailing Address - Fax:
Practice Address - Street 1:788 8TH AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2106
Practice Address - Country:US
Practice Address - Phone:319-398-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA095388363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical