Provider Demographics
NPI:1174832893
Name:REANEY, AMANDA RAE (MSPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RAE
Last Name:REANEY
Suffix:
Gender:F
Credentials:MSPAS, PA-C
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Mailing Address - Street 1:3204 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5255
Mailing Address - Country:US
Mailing Address - Phone:618-922-3739
Mailing Address - Fax:
Practice Address - Street 1:3204 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5255
Practice Address - Country:US
Practice Address - Phone:618-922-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2013-04-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant